Mariska Tuut

Step-by-step guide 215 6 Appendix 6. Detailed feedback on the step-by-step guide from DECIDE workshop participants Question Agreement Feedback Do you think the approach we presented today is useful in understanding the context and place of a test? (yes/no) 19/19  The pathway definition does not necessarily need to be the first step in guideline development  There may be more than one pathway for a given test strategy  Some pathways maybe challenging due to variation in practice  A multidisciplinary team may be needed going across primary, secondary, and tertiary care in order to establish accurate, comprehensive, factual information on the pathway Does it give insight into the different types of evidence needed? (yes/no) 14/17 More information and guidance on defining clear inclusion and exclusion criteria for the evidence search is needed What do you think of the structure (PICO) and flow of questions in this approach?  The visualisation was helpful to get a picture of missing information  The approach is good as an initial starting point to developing the pathway  It is difficult to establish a smooth flow of questioning since discussions tended to go off tangent into individual benefits versus population benefits and/or harms or if an entire panel is involved  There was expectation of a software to support this approach  Starting and ending with the patient outcomes maybe more appropriate  The Interviewer must have some background information about the health problem  The approach should be more about Bayesian steps of pre-test probability estimates derivation and sequence of diagnostic ins- and rule-outs.  Defining the clinical outcomes was difficult Would you consider using this approach in developing a guideline? (yes/no) 18/19  The process should engage the full guideline panel  Different strategies could be used for getting different perspectives: e.g. focus group or one to one interviewing with an inductive approach  These pathways are not only useful for diagnostic tests but also for treatments  It seems time-consuming with a need for healthcare professionals and guideline panels to be "trained" or "used to" this approach  The approach was not explicit enough on how it can be used in practice to help guideline development / make recommendation  Discussions about the reference standard can cause discussions to go off tangent and to reach consensus

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