224 Chapter 7 we developed the draft version of the guide and tested it among experts in a workshop. The guide was recently refined and updated, and then tested among seven guideline panel members. As a result, an introduction, instructions and a visualisation of the test-management pathway were added. The final step-by-step guide assists guideline developers in formulating structured questions by identifying important characteristics of the population, the test(s), people-important outcomes, and the link between testing and these outcomes. Strengths and limitations The case study on evaluating sIgE for diagnosing allergic rhinitis highlights challenges faced by guideline methodologists and offers practical solutions. However, we did not consult guideline panels, which could have been more efficient, for example in determining people-important outcomes and discussing the critical elements of the test-management pathway. Although only one case was systematically analysed, the results of the study reflect a wide range of guidelines, as the challenges identified are common and the proposed solutions are considered feasible based on own experience. Our document analysis study, which demonstrated that guidelines on testing are not transparently based on evidence for all parts of the test-management pathway, showed consistent results across the three different tests, supporting the generalisability of the results. However, if we had been able to include tests with other than diagnostic purposes, this might have widened the scope. For example, recommendations for monitoring tests may place more emphasis on, for example, test burden (e.g. frequent visits) and management effectiveness. Another weakness of this study is the lack of information about the dynamics in the guideline panels. It is therefore unclear whether a guideline panel considered test consequences, such as test burden, management effectiveness, and linked evidence, or based their recommendations solely on information about test accuracy. It is possible that guideline panels did consider these consequences but chose not to include them in the published guideline. This may be the case because they did not feel it was necessary or because they deemed some parts of the test-management pathway were irrelevant to the topic of interest. Our research on the knowledge required for developing healthcare related testing guideline recommendations was conducted through a purposeful combination of literature review and interviews with nine international opinion leaders from various countries and perspectives. These perspectives include test evaluation, guideline development about testing, and consumer involvement. A limitation of this study is
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