General discussion 225 7 that it only focused on the cognitive domain of required competencies. In guideline development, skills and attitudes are also important. However, compared to other domains of guidelines, such as treatment guidelines, the required skills and attitudes are not expected to be significantly different for guidelines on testing. Competencies for guideline development are described in various tools such as the Guideline Participation Tool and the Checklist for Guideline panel Chairs, and incorporated in the GIN-McMasters Guideline Development Checklist and include committing to the process, being clear on roles, familiarising with guideline methodology, preparing for meetings, contributing to discussions in a fair and equitable manner, maintain confidentiality, and being respectful [2-5]. In our study on the step-by-step guide for formulating focused questions, we tested the guide among guideline experts and regular guideline panel members, which supports its validity. However, it is important to note that some of the data collected was conducted over a decade ago, which may now be outdated. Therefore, we have incorporated new insights into the final guide. Furthermore, the guide was tested in controlled settings rather than in a real guideline panel. Implementing the guide in guideline panels may require additional attention. Overall, this thesis combines various study designs, including literature and document analyses, as well as developmental studies. Insights from the updated framework for developing and evaluating complex interventions from the Medical Research Council (MRC) were utilised [6]. The MRC framework is based on dynamic, iterative, and creative principles. When planning the development of an intervention, the first step is to have a thorough understanding of the problem and the potential for an intervention [7]. This involves analysing the problem and using collaborative and user-centered approaches to customise interventions to the context of guideline development [8]. The research presented fills a gap in knowledge and addresses a practical need. All studies were conducted with the aim of international applicability, requiring no local adaptation (except for possible translations). This research focuses on guideline panel members, including healthcare professionals and patient representatives, and guideline panels as a whole, particularly with regard to the knowledge components and the step-by-step guide. This approach aligns with competency-based frameworks for guideline development and training courses, such as the INGUIDE Certified Guideline Panel Member Course [9, 10]. In the interview study, where we identified required knowledge components to develop guideline recommendations for healthcare related testing, there was some debate about whether the requirements for patient representatives would be the same as for
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