22 Chapter 1 This has led to the following research questions: 1. What are challenges and possible solutions when assessing the certainty of evidence of a test-management pathway? 2. Which types of evidence (diagnostic accuracy, burden of the test, natural course, treatment effectiveness, link between test result and administration of treatment) are used to support guideline recommendations about testing? 3. What is the minimum knowledge required for guideline panel members involved in developing recommendations about testing? 4. Can a step-by-step guide aid guideline developers in formulating key questions about testing? Outline of the thesis After this introduction chapter, chapter 2 presents findings from a case study on the application of GRADE for tests and test strategies, including the identification of methodological challenges, and suggestions for solutions to these challenges (research question 1). This study evaluated the full test-management pathway for the net benefit of IgE (immunoglobulin E) in the diagnosis of allergic rhinitis. Chapter 3 presents a systematic document analysis including quality assessment of publicly available guidelines on three diagnostic tests: C-reactive protein, colonoscopy, and fractional exhaled nitric oxide. This study evaluated the incorporation of the various components of the test-management pathway in the evidence base for the guideline recommendation, including factors contributing to the comprehensiveness of the evidence as well as explanations for eventual differences between the guidelines (research question 2). Chapter 4 presents the results of a developmental study with the aim of defining the minimum knowledge required by guideline panel members who are involved in developing recommendations about testing. This study used a literature review and expert interviews to formulate a list of required knowledge components (research question 3). During the development and presentation of the required knowledge components, it became clear that practical examples of test-management pathways were needed. Chapter 5 provides detailed examples that can aid in the understanding and implementation of the test-management pathway concept. Chapter 6 presents the outcomes of developing and testing a step-by-step guide for guideline developers. The guide’s objective was to assist guideline panel members in formulating key questions regarding testing (research question 4). Finally, chapter 7 offers a general discussion summarising the results of the studies, reflecting on these results, and outlining implications for practice. Additionally, it provides suggestions for further research.
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