Mariska Tuut

252 The list of knowledge components required for guideline panel members to adequately develop recommendations on healthcare related testing consists of 26 items. These items cover the topics health question, test-management pathway, target population, test, test result, interpretation of test results & subsequent management, and impact on people-important outcomes. The required level of knowledge for each component is also defined. Understanding the test-management pathway concept appears to be the key knowledge component, linking all other essential knowledge components. Chapter 5 provides four practical examples of test-management pathways for test scenarios in various settings, purposes, and roles. For each test-management pathway example concrete details are meticulously described, for educational purpose. The need for such examples became apparent during the interviews in chapter 4 and in academic presentations on this topic. The scenarios include various types of tests: self-testing, screening, diagnostic testing, and follow-up testing. These examples can be used by guideline methodologists, guideline panel chairs, and trainers to help guideline panel members understand and adopt the test-management pathway concept. Chapter 6 addresses the fourth research question. In this developmental study, we created a step-by-step guide for guideline developers to specify a test-management pathway using a co-creative design. The draft guide underwent user testing in a workshop with nineteen healthcare professionals and researchers who have expertise and/or interest in guideline development. The adjusted step-by-step guide was subsequently user-tested in a before-after approach. Seven guideline panel members were asked to formulate a guideline question on testing, first without and subsequently with the use of the step-by-step guide. The step-by-step guide for specifying a test-management pathway consists of five blocks with signalling questions, which emphasise people (including setting and timing), the index test, outcomes of interest, linking outcomes to testing, and comparator. The user can change the order of the steps and questions. Participants found the step-by-step guide helpful for structuring questions and defining the purpose and impact of the test of interest, and were intended to use the guide in a guideline panel setting. The guide should facilitate guideline developers in defining guideline questions on healthcare related testing by identifying relevant elements, which is an essential step in guideline development. Chapter 7 provides an overview of the results presented in this thesis and a general discussion based on these findings, including a general reflection on methodological strengths and limitations. The thesis highlights the challenges of developing guideline

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