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Barriers to making recommendations about medical tests: a qualitative study of European guideline developers
  1. Gowri Gopalakrishna1,
  2. Mariska M G Leeflang1,
  3. Clare Davenport2,
  4. Andrea Juliana Sanabria3,
  5. Pablo Alonso-Coello3,
  6. Kirsten McCaffery4,
  7. Patrick Bossuyt1,
  8. Miranda W Langendam1
  1. 1Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
  3. 3Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Pau), Barcelona, Spain
  4. 4School of Public Health, Sydney Medical School, Public Health Section, Centre for Medical Psychology and Evidence based Decision Making (CeMPED), Sydney, New South Wales, Australia
  1. Correspondence to Gowri Gopalakrishna; g.gopalakrishna{at}


Objectives Development of medical test guidelines differs from intervention guideline development. These differences can pose unique challenges in building evidence-based recommendations to guide clinical practice. The aim of our study was to better understand these challenges, explore reasons behind them and identify possible solutions.

Setting and participants In this qualitative study, we conducted in-depth interviews between February 2012 and April 2013 of a convenience sample of 17 European guideline developers experienced in medical test guideline development.

Outcomes measured We used framework analysis with deductive and inductive approaches to generate the themes from the interviews. We kept interpretation grounded in the data.

Results Guideline developers acknowledged that inclusion of patient important outcomes in their guideline development was necessary but lacking. This and other challenges raised fell into 3 broad and overlapping domains: methodological issues, resource limitations and a lack of awareness on the need for evidence that links testing to patient outcomes. Education was mentioned as a key solution to increase awareness and address the resources limitations mentioned.

Conclusions Challenges guideline developers face were interlinked across the domains of methodological issues, resource limitations and a lack of awareness. Solutions that addressed these challenges in parallel are needed. Raising awareness, education and training of relevant stakeholders such as medical doctors, funders and regulators to look beyond test accuracy is key to having a long-term resolution to the issues faced in medical test guideline development.

  • medical tests
  • guideline development
  • test accuracy
  • medical education
  • in depth interviews

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