General discussion 233 7 panel members. An identical study design could be used, with input from international experts in this field. This would enable and facilitate the implementation of the testmanagement pathway concept into guideline development. Furthermore, there is a lack of evidence regarding the needs of guideline panel members and other people involved in guideline development. Determining these needs would enable the development and delivery of appropriate training. However, it is possible that there may be a wide range of needs, for example depending on educational background and role of guideline panel members, necessitating tailored training. Therefore, to design such training, methods from educational design research seem indicated. Purposes of such training ('why’) should be linked to actions (‘how’), supported by arguments. Such methods includes collaborative, user-centered, and iterative approaches to customise interventions to the context of guideline development [8]. Additionally, it is recommended to evaluate the effectiveness of the step-by-step guide for specifying the test-management pathway in 'living labs' rather than in a controlled setting with a single guideline panel member. This involves assessing the use of the guide, as well as the factors that facilitate or impede its implementation, in real-world guideline development settings, specifically within guideline panels. Ideally, this evaluation should be conducted using an online version of the tool, which is expected to be more efficient and interactive. Finally, in addition to the step-by-step guide for specifying the test-management pathway, it may be beneficial to develop and test additional tools to facilitate guideline developing on healthcare related testing. For example, tools could be created to aid in the interpretation of false positive, false negative, and inconclusive test results, or for interpreting evidence related to the elements of the test-management pathway, and tested in a user-centered design. Furthermore, it would be useful to investigate whether particular instruments are necessary to move from evidence to recommendations when creating guidelines for healthcare related testing.
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