Summary 251 complete test-management pathway. To save time, consulting panel members, including patient representatives, may be a practical solution for selecting critical elements of the pathway for which a systematic review of the evidence should be undertaken. For less critical elements, the guideline panel may then refer to other guidelines, grey literature, professional expertise, and professional and consumer experience. The guideline panel can provide recommendations on the methodological approach for each element of the test-management pathway. Chapter 3 addresses the second research question. This chapter evaluates the extent to which evidence-based guidelines on tests cover all elements of the testmanagement pathway. Specifically, it examines publicly accessible guidelines on three common tests: C-reactive protein (CRP) to estimate the likelihood of pneumonia, colonoscopy to detect colon cancer, and fractional exhaled nitric oxide (FeNO) to diagnose (severe) asthma in a systematic document analysis. Fifteen national and international guidelines published between 2016 and 2020 were analysed. The guidelines’ methodological quality was evaluated using AGREE-II domain methodology, and it varied from poor to excellent. Test accuracy was considered in the development of ten out of fifteen guideline recommendations, with four of them being based on a systematic review and rating of the certainty in the evidence. None of the guidelines included an evaluation of all steps of the test-treatment pathway. Three guidelines included consideration of test burden and two of natural course, but without a systematic review of the evidence. Of the three guideline recommendations that included consideration of management effectiveness, one based this on a systematic review and rating of the certainty in the evidence. The link between test results and management was not considered in any of the guidelines. Reporting issues and challenging methodology may explain the lack of transparent consideration of all elements of the test-management pathway. Chapter 4 addresses the third research question. This is a developmental study, in which we determined the minimum knowledge required for guideline panel members involved in developing recommendations on healthcare related testing. We determined a draft set of knowledge components based on literature review. Subsequently, semi-structured interviews were conducted with nine internationally respected experts in testing in healthcare, test evaluation, guideline development including GRADE for tests, public involvement in guideline development, and training in guideline development on healthcare testing. The knowledge components were modified based on feedback from the interviewees and approved by all study participants.
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