General discussion 221 7 General discussion In this discussion chapter I first summarise the main findings, followed by a reflection on the strengths and limitations of the thesis. In the section ‘reflections’ I put the findings in perspective, to subsequently come to interpretations considering the strengths and limitations and relevant recent literature, concerning the topics testmanagement pathway concept, from guideline to practice including the diagnostic process and patient/public information, and overdiagnosis. The discussion ends with a description of the conclusions and recommendations for practice and further research. This thesis aimed to facilitate and improve guideline development concerning healthcare related testing. The objectives were to explore current practices and challenges, identify required knowledge, and develop and test a tool to formulate appropriate guideline questions. The following research questions were addressed: 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? Main findings This thesis emphasises the importance of the test-management pathway concept (figure 1) in guideline development. The rationale for this concept is that healthcare related tests are typically not used in isolation, and that testing in itself regularly has no direct impact on people-important outcomes. Health question Test-management pathway Target population Testing Testing result Including burden Impact on people- important outcomes Interpretation of testing results & subsequent management Including burden Figure 1. Test-management pathway concept
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