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Evidence-Based Practice

Defining the Question

Understanding the types of questions healthcare professionals ask is crucial for effective evidence-based practice. Think of the question as a roadmap guiding your evidence-based practice journey. Just as different terrains require specific tools and methods for navigation, different types of questions necessitate specific approaches and resources to find the best evidence. 

Background questions are broad and foundational, typically seeking general knowledge about a condition, treatment, or disease process. 

Foreground questions, or clinical questions, are more specific and focused, asking how therapies, diagnostic tests, and other interventions compare in terms of efficacy. These questions reflect the choices healthcare professionals and patients encounter when making care decisions.

Purpose
Background Questions
Foreground Questions
Therapy What are the best practices for wound care management?

 

 In adult patients with type 2 diabetes and chronic foot ulcers, how does negative pressure wound therapy (NPWT) compare to standard moist wound dressing in terms of the rate of wound healing?
Diagnosis What imaging tests are used for confirming a diagnosis of pneumonia in patients presenting with signs and symptoms? In children aged 6-10, presenting with symptoms of pneumonia, how does chest X-ray compare to lung ultrasound in accurately diagnosing the condition?
Prognosis What factors influence the prognosis of patients with heart failure? In elderly patients with heart failure, how does the presence of comorbid diabetes mellitus compare to the absence of diabetes in predicting long-term survival rates?

By distinguishing between the types of questions, healthcare professionals can more efficiently search evidence-based medicine resources and navigate the medical literature.

Source: American Medical Association, Guyatt G, Rennie D, Meade M, Cook D. Users' Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. 3rd ed. McGraw-Hill Education; 2015.

Structuring the Clinical Question

Formulating a good clinical question using the PICO(T)(S) framework involves breaking down your question into specific components. We have used an alternate version of the PICO question to include Time (if relevant) and Study (if a certain type of study design is used) to allow the question to be as comprehensive as possible.

PICO(T)(S) Framework

  1. P (Patient/Problem):

    • Background Information: Describe the patient group or problem. This includes demographic details like age, gender, ethnicity, and specific conditions or diseases.
      • Example: “In adults aged 40-60 with hypertension…”
    • Clinical Questions: Focus on the clinical aspects of the patient or problem.
      • Example: “In adults with hypertension…”

  2. I (Intervention):

    • Specify the main intervention you are considering. This could be a treatment, diagnostic test, procedure, or exposure.
      • Example: “Does the use of ACE inhibitors…”

  3. C (Comparison):

    • Identify the main alternative to compare with the intervention. This could be a placebo, different treatment, or no treatment at all.
      • Example: “…compared to beta-blockers…”

  4. O (Outcome):

    • Define what you aim to accomplish, measure, improve, or affect. Outcomes can be specific (e.g., reduction in blood pressure) or general (e.g., improved quality of life).
      • Example: “…reduce the incidence of stroke?”

  5. T (Time, if relevant):

    • Include the timeframe over which the intervention is applied or the outcome is measured. This is optional but can be important for certain questions.
      • Example: “…over a period of 6 months?”

  6. S (Study Design):

    • Specify the type of study design that would best answer the question. This could be a randomized controlled trial (RCT), cohort study, case-control study, etc.
      • Example: “In a randomized controlled trial…”

 

Example of a PICO(T)(S) Question

In adults with hypertension (P), does the use of ACE inhibitors (I) compared to beta-blockers reduce the incidence of stroke (O) over a period of 6 months (T) in a randomized controlled trial (S)?

By breaking down your question into these components, you can create a focused and structured clinical question that is more straightforward to research and answer.