Library: Evidence-Based Practice: Finding the Evidence

Developing focused clinical questions

There are two main types of questions that may arise from a patient dilemma:

Background questions address general queries about a particular disease, condition, test or treatment and can often be answered sufficiently using medical textbooks or point-of-care tools (e.g. UpToDate).
Foreground questions address aspects of care, therapy options or possible outcomes in relation to a specific patient or situation and require a more in-depth literature search to find the answer.

Answering foreground questions involves developing well-formed, focused clinical questions.

Firstly, ensure you have mapped your review questions using PCC and refined the parameters in a clearly articulated protocol. You can then use your PCC ( participant, concept, context) breakdown to build your search strategy. (Recommended by JBI)

PCC - Term - Keywords - MeSH

The PICO framework is commonly used to translate and structure patient dilemmas into focused questions. A method promoted by organisations such as the Centre of Evidence-Based Medicine in (CEBM) in Oxford. Using PICO helps to identify the important concepts for your search strategy and makes searching for evidence easier and more time effective.

It will direct your search to relevant and precise answers.

PICO for clinical questions framework:

Patient, population or problem:

Patient, population or problem - What are the characteristics of the patient or population (e.g. disease or condition, age, gender)?
Intervention, exposure, Prognostic factor - What is the main intervention of interest (e.g. drug or other treatment, diagnostic/screening test)?
Comparison - What is the alternative being considered (e.g. standard therapy, placebo, no treatment)?
Outcomes - What are the relevant outcomes (e.g. reduced risk of mortality, return to function, accurate diagnosis?
Type of question - See below.
Type of study - Systematic review / RCT / cohort study / case-control

Types of foreground questions

There are five different types of foreground questions, each focusing on a different action in response to the clinical problem.
Identifying the type of question will help focus your search to the best study type using clinical queries filters.

Therapy/Intervention/Treatment
Diagnosis (Differential and tests)
Prognosis
Harm/Etiology
Prevention

PICo for qualitative questions (looks at people's experiences, attitudes, beliefs, opinions, perceptions etc.)

Alternative question formulation structures with links for more information:

SPICE (qualitative) Setting, Population, Intervention, Comparison, Evaluation

PECODR (clinical) Patient, Exposure, Comparison, Outcome, Duration, Results

PESICO (rehabilitaton) Patient, Environment, Stakeholders, Intervention, Comparison, Outcome

COPES (social work) Client-Oriented, Practical, Evidence Search
Client and problem / What you might do / Alternate course of action / What you want to accomplish

ECLIPSE (health management, policy) Expectation, Client group, Location, Impact, Professionals, SErvice

PIPOH (guidelines) Population, Interventions, Professionals/Patients, Outcome, Health Care Setting

SPIDER (qualitative - Attitudes & experiences) Setting/Sample, Phenomenon of, Interest. Design, Evaluation, Research type

Additional answerable question frameworks
PICO search strategy worksheet
The following worksheet can be used to help in developing your search strategy

PICO Portal

Workbooks

Evidence for success guide: the guide to getting evidence and using it Evaluation Support Scotland, 2014. The guide offers easy to follow, step-by-step guidance and resources to support organisations to use evidence to influence policy and practice.
Evidence-based answers to clinical questions for busy clinicians Centre for Clinical Effectiveness (Clinicians, Consumers, Evidence) - Workbook 2011

Study Designs

Study Design 101

Each type of question is best answered by different types of research studies. Knowing which type of question you are asking will help you decide which resources you need to locate.

Question type	Definition	Best study design
Therapy	The effect of an intervention/s on a patient	Randomised Controlled Trial (RCT)
Diagnosis	Ability of a test to differentiate between those with or without a condition	Prospective, blind comparison to a gold standard
Harm/aetiology	The effect of potentially harmful agents	Cohort study or Case control study
Prognosis	The likely progression, outcome or survival time for a condition	Cohort study
Prevention	Reducing chance of a disease by changing risk factors or early diagnosis & treatment	RCT

OVID PICO Search

EBP Tutorials

Please note that tutorials from other institutions will refer to their own resources.

Check this subject guide or the CAHS library website to locate the same or similar resources.

Answering clinical questions (UWA) Module 1 - Formulating a clinical question, Module 2- Find the best evidence, Module 3 - Appraise the evidence, Module 4 - Apply the evidence
Dissecting the literature: the importance of critical appraisal
EBP e-learning International Centre for Allied Health Evidence
EBP PICOT Research on Ovid (Part 1)
EBP PICOT Research on Ovid (Part 2) Video Tutorial
Evidence-Based Practice: Improving Practice, Improving Outcomes - Part 1 OvidWoltersKluwer
Evidence-Based Practice: Improving Practice, Improving Outcomes - Part 2 Lippincott NursingCenter.com
Find it Fast Video tutorials by Yale University (Harvey Cushing/John Hay Whitney Medical Library)
Introduction to evidence-based practice Duke University & the University of North Carolina

Tutorials on formulating a clinical question

Answering Clinical Questions: UWA & other resources UWA Faculty of Medicine, Dentistry & Health Science
Formulating Answerable Clinical Questions Evidence-based toolbox. Knowledge Translation Program
Well Built Clinical Question (PICO) Worksheet Duke University