Guideline organizations’ guidance documents paper 10: developing recommendations about diagnostic tests and strategies

BACKGROUND AND OBJECTIVES: Diagnostic tests are central to clinical decision-making, but the rigor and consistency of guidelines that inform their use remain unclear. This study aimed to describe processes for developing recommendations about diagnostic tests and strategies as outlined in guidance documents of guideline-producing organizations. METHODS: We conducted a descriptive summary of guidance documents from guideline-producing organizations. We first compiled a list of eligible organizations using different sources and retrieved their guidance documents on practice guideline development. Two authors screened organizations and their documents in duplicate and independently. We abstracted information on whether organizations provided guidance on developing recommendations about diagnostic tests and strategies for each of the Guideline International Network McMaster Guideline Development Checklist topics and their corresponding details. RESULTS: Out of 133 guideline-producing organizations identified, 44 (33%) described processes for developing recommendations about diagnostic tests and strategies in their guidance documents. The majority of these organizations were professional (52%) and were at the national level (80%). The median number of topics for which guidance specific to diagnostic tests and strategies was provided was 1 (range = 1-5). The topics most frequently addressed were "judging the quality, strength, or certainty of evidence" (55%) and "question generation" (32%). Topics not addressed by any organization were "establishing guideline group processes," "identifying target audience and topic selection," "consumer and stakeholder involvement, " "conflict of interest considerations," "dissemination and implementation," and "updating." CONCLUSION: A minority of guideline-producing organizations' guidance documents mentioned specific processes for developing recommendations for diagnostic tests and strategies. Further refinement of guidance tailored to diagnostic tests is needed to improve practice guideline development processes.