226 Chapter 7 healthcare professionals in a guideline panel. This was not systematically analysed, however, all interviewees agreed that the test-management pathway concept should be understood by everyone in the guideline panel. Additionally, it would have been beneficial to investigate systematically if the support needs of patient representatives differ from those of healthcare professionals in a guideline panel. The GIN Public Toolkit provides practical advice for guideline developers on involving patients and public in guideline activities. It was developed by the Guidelines International Network and offers for example best practices and tips for successful patient and public involvement [11]. It may be worth considering whether these tools should be adapted for guidelines that include key questions about healthcare related tests. Furthermore, it is important to note that other roles within the guideline panel, such as guideline methodologists and guideline panel chairs, may require different knowledge and tools to optimize their work. These competencies and tools are not included in this thesis. During the first phase of this thesis, we identified challenges and suboptimal practices. In the second phase, we provided knowledge components and a tool to facilitate the development of guidelines for healthcare related testing. It is unclear whether implementing the required knowledge, such as through training, and following the step-by-step guide will actually enhance the guideline development process and result in better recommendations for healthcare related testing to improve people-important outcomes. Further studies will be required to determine whether and how these instruments improve guideline panel processes and future guideline recommendations. This thesis presents a series of studies that concentrate on creating guidelines for healthcare related testing. The evaluation of evidence regarding the benefits and harms of testing in a test-management pathway is a major focus, with particular emphasis on people-important outcomes. This is a crucial aspect of guideline development, highlighting the challenges involved, which is a strength of the thesis. However, it is important to acknowledge that the process of moving from evidence to recommendations may present additional challenges. A weakness of this thesis is that these considerations were not included in the research. It is unclear whether such considerations vary between treatment guidelines and testing guidelines. The GRADE working group has identified several factors that should be considered when formulating guideline recommendation, including values and preferences, resource use, cost-effectiveness, equity, acceptability, and feasibility [12-19]. These factors are addressed in the evidence-to-decision framework (EtD) and apply to both testing and treatment recommendations [1]. However, it is unclear whether addressing these factors in the development of testing recommendations requires specific knowledge
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