Decision-making about healthcare related tests and diagnostic strategies: International guidelines show variability in their approaches.

Publication date: Available online 14 September 2017
Source:Journal of Clinical Epidemiology
Author(s): Reem A. Mustafa, Wojtek Wiercioch, Ingrid Arevalo-Rodriguez, Adrienne Cheung, Barbara Prediger, Liudmila Ivanova, Matthew Ventresca, Jan Brozek, Nancy Santesso, Patrick Bossuyt, Amit X. Garg, Nancy Lloyd, Monika Lelgemann, Diedrich Bühler, Holger Schünemann
ObjectiveTo describe and compare current practices in developing guidelines about the use of health care related tests and diagnostic strategies (HCTDS)Study Design and SettingWe sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions.ResultsDetailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described and referenced the evidence that linked test accuracy and patient-important outcomes.ConclusionThere is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition.



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