General discussion 223 7 (CRP) to increase the likelihood of pneumonia, colonoscopy to detect colon cancer, and fractional exhaled nitric oxide (FeNO) to diagnose (severe) asthma. We analysed fifteen publicly available national and international guidelines published between 2016 and 2020 and in force at that time. Ten of these fifteen guidelines assessed the accuracy of the test, but only four of these supported the assessment with a systematic review of the literature, including an evaluation of the certainty of the evidence. The remaining elements of the test-management pathway (i.e. test burden, natural course of the disease of interest, management effectiveness, and linked evidence) were hardly considered in a transparent way. As critical appraisal of the evidence beyond test accuracy appeared challenging and current practice is suboptimal, we were keen to facilitate the process of guideline development about healthcare related testing. However, existing competency-based frameworks for guideline developers do not adequately address the expertise required for test evaluation. Thus, we conducted a developmental study to determine the knowledge required for guideline panel members to effectively contribute to the development of healthcare related testing recommendations. Based on literature review and nine semi-structured interviews with international experts on the topic, we compiled a list of 26 knowledge components across seven domains: health question, test-management pathway, target population, test, test result, interpretation of test results & subsequent management, and impact on people-important outcomes. For each knowledge component, we defined the necessary level of knowledge. The key component appeared to be understanding and insight into the concept of the testmanagement pathway, which helps to focus on people-important outcomes. The other required knowledge components, such as the formulation of the purpose and role of a test and the interpretation of false positive and false negative test results in terms of people-important outcomes, fit seamlessly in this concept. In a separate manuscript, we have provided examples of test-management pathways for different test scenarios. These examples can be used by guideline methodologists, guideline panel chairs and trainers to facilitate the understanding of the test-management pathway concept by guideline panel members. Since the test-management pathway concept is a crucial knowledge component, we conducted a study to develop and test a step-by-step guide for formulating focused questions about healthcare related testing through drafting such a test-management pathway. This study was already initiated over a decade ago as part of the DECIDEproject, an EU-funded project aimed at developing and evaluating methods for disseminating guidelines, including evaluating evidence and developing recommendations for healthcare related tests [1]. During the DECIDE-project, which
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