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EBM and EBP: Formulating an Evidence-Based Clinical Question

Evidenced Based Practice: Ask a Clinical Question

Phrasing your question:

The first stage of any evidence-based practice process is formulating an answerable question. This forms the foundation for quality searching. A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question. Poorly thought out questions (often posed as statements or title statements) often lead to unfocused research and affect outcome quality. It is crucial to effectively communicate the relevance, pertinence and focus of your research question to your audience.

As the Question is the main point of your research, it is important to take time and find out:

  • Do you know the field and its literature well? 
  • What are the important research questions in your field? 
  • What areas need further exploration? 
  • Is the timing right for this question – hot topic or obsolete? 
  • Will the question have a significant impact on this field?

 

Evidence-based practice: Ask a Clinical Question 1

PICO(T) framework.

An answerable question can have the framework as follows. The PICO Framework can help to identify suitable keywords for your search strategy. The acronym translates to:

P – Population/Patient/Participant/Problem

I –  Intervention, Issue, Treatment or Exposure*

C – Comparison/Control

O – Outcome

Optional model component:

T -- Timeframe for data collection or time taken to demonstrate a clinical outcome

The ProPHeT or SPIDER Frameworks

There are many other mnemonic search aids that can assist you in setting up your search question. These are some of the more popular frameworks. They can be the basis for more complex qualitative research adaptations. 

 ProPHeT Framework - PROblem, PHEnomenon, Time

SPIDER Framework -   Sample, Phenomenon of interest, Design, Evaluation, Research type

The Spider format enables research questions to include and evaluate experiences a specific phenomenon.

Further information:

Framing a research question (University of Maryland with a number of mnemonic search models)

Evidence-Based Practice: PICO and SPIDER (© Charles Stuart University)

Ask an Evidence based Clinical Question (© University of South Australia includes clinical question example modules)

What is PICO? 

Do you want to know whether a Cochrane Review is relevant to you? 
Cochrane Review Pico outlook 

 

Evidence-based practice: Ask a Clinical Question 2

SVHM Library perspective on research questions

While the PICO format and other search mnemonic models have been very successful in recent years their static usage have come into question. No formula or model is bulletproof as a direct structure for all clinical research questions. At SVHM Library we try to focus on the research question at hand, by researching the subject well and by following a simple, systematic search strategy outline. This provides a systematic search structure and overview which is very helpful in keeping documentation and records of your search steps. Recording your searches and results is imperative for when you need to write up your search methodology and results. 

Plan, search and document your topic/subject systematically 

Systematic reviews: The question (Helen Wilding SVHM Library)

Searching in the databases:

The Process and example of systematic searching

Example topic "Meditation for people with diabetes"

1. Break down your search into simple, separate concepts -use a search planner or word doc table to keep a record of your terms and the results you achieve from each database

  • Meditation 
  • Diabetes

2. Explore synonyms for your separate concepts (meditation, transcendental meditation, mindfulness, body relaxation)
3. Always search one concept at a time. First with subject headings, then with appropriate keywords, then combine with OR
4. The exp and forward slash / is an indication of a subject heading and the .ti,ab. are keyword search fields in the title and abstract
5. Always search each component as subject headings and keywords then combine with OR
6  For your final set: all terms from the  2 ways of searching then combine with AND