Summary 253 recommendations on healthcare related testing, including the frequent lack of evidence for critical elements of a test-management pathway, and the time required to adequately evaluate the evidence. The thesis highlights the significance of the testmanagement pathway concept in guideline development on healthcare related testing. This is crucial to understand for guideline panel members when developing guideline recommendations on healthcare related testing. The thesis also provides examples of test-management pathways and a step-by-step guide for specifying such pathways. These can help to understand the importance of the test-management pathway concept and facilitate the formulation of key questions about healthcare related tests. The research focuses on evaluating the evidence and facilitating guideline panel members in the guideline development process. It does not cover the process of moving from evidence to decision and the roles of guideline methodologists and guideline panel chairs. In addition to the previous described results, the research has prompted reflections on the concept of test-management pathways. These include the use of more inclusive language over time, as well as a recurring debate regarding the definition of test burden. Furthermore, in published evidence, there is a great focus on diagnostic tests and dichotomous test results, whereas other purposes and test results are less discussed. It is acknowledged that test evaluation in guideline development occurs in a simplified version of reality. Guideline developers should be aware of these insights. Additionally, it is important to raise awareness about the potential downsides of testing, not only in scientific and guideline development environments, but also in the context of shared decision-making. Implementing the test-management pathway in healthcare policymaking could potentially reduce overtesting, overdiagnosis (including overdetection and overdefinition), and subsequent overtreatment. This involves evaluating the net benefit of testing on people-important outcomes in guideline development. Recommendations for practice include emphasising the importance of the testmanagement pathway concept when updating guidance on guideline development, incorporating this concept into training of guideline panel members and methodologists, and creating an online tool to specify the test-management pathway by guideline panels. Recommendations for research include identifying the required knowledge for guideline methodologists and guideline panel chairs to develop recommendations on testing, evaluating the step-by-step guide for specifying the testmanagement pathway in guideline panel settings, and developing and testing educational strategies and tools to facilitate guideline development on healthcare related testing.
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