Evidence Based Practice: Formulating an Evidence-Based Clinical Question

Clinical questions arise around the central issues involved in caring for patients. It is helpful to narrow down the type of clinical question you are asking. There are four main types of clinical questions:

    1. Therapy:             questions concerning the effectiveness of a treatment or preventative measure.

    2. Harm/Etiology:  questions concerning the likelihood of a therapeutic intervention to cause harm.

    3. Diagnosis:         questions concerning the ability of a test to predict the likelihood of a disease.

    4. Prognosis:         questions concerning the future course of a patient with a particular condition.

Shared with kind permission from: Research Medical Library, The University of Texas MD Anderson Cancer Center

Phrasing 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. The wording of your question sets expectations and captures the essence of your research. 

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There are many excellent online resources that explain the principles of evidence-based literature searching and the PICO framework:

As the Question is the main point of your research, it is important to spend some time asking yourself:

• 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?

Once these points have been addressed, then: 

1 Specify your specific concern or issue 

2 Decide what you want to know about the specific concern or issue 

3 Turn what you want to know and the specific concern into a question 

                             Suggested phrases to include in your question:

                                                      To what extent / degree...

                                                      How effective is...

                                                      What is the affect of ... role / significance of...

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4 Ensure that the question is answerable

5 Check to make sure the question is not too broad or too narrow

The PICO model can then help in the process of formulating your topic, into an evidence-based clinical, answerable question. This forms the foundation for quality searching and assists in determining whether the evidence retrieved is relevant to your question.

PICO(T) Framework
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.
An answerable question has a format that follows the PICO(T) framework. 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

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*To avoid the search becoming too broad, it is advisabe to apply one intervention only at a time. Applying other interventions may need to be separate searches.   

The PICO Framework helps to identify suitable keywords for your search strategy.

The Who, What, Where, How then may help to inform the type of research you undertake: E.g. Qualitative; Quantitative; Mixed Methods; Grounded Theory…

Other "Question Formulation" Models to consider:

The ProPHeT and SPIDER Frameworks

 ProPHeT Framework

  PROblem

    PHEnomenon

    Time

SPIDER Framework

    Sample

    Phenomenon of interest

    Design

    Evaluation

    Research type