Gatiti, Peter

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eCommons@AKULibrariesApril 2010Evidence- based practice: formulating a well-builtclinical questionPeter GatitiAga Khan University, peter.gatiti@aku.eduFollow this and additional works at: http://ecommons.aku.edu/librariesPart of the Library and Information Science CommonsRecommended CitationGatiti, P. (2010). Evidence- based practice: formulating a well-built clinical question. Mid Yorks Medical Journal, 1(2), 27-29.Available at: http://ecommons.aku.edu/libraries/13Mid Yorks Medical Journal, Volume 1, Issue 2 Page 27         April 2010  IN EDUCATION  Evidence- based practice:  formulating a well-built clinical question  Peter Gatiti Specialist Librarian Mid Yorkshire Hospitals NHS Trust peter.gatiti@midyorks.nhs.uk The evidence-based practice process  The essentials of evidence based practice (EBP) have been defined by Sackett et al1. They include:   • Formulating a well-built question  • Identifying articles and other evidence-based resources that answer the question  • Critically appraising the evidence to assess its validity  • Applying the evidence  • Re-evaluating the application of evidence and areas for improvement  In this series of articles, we discuss various  aspects of evidence-based practice and the  available support in order for you to embed this in your clinical practice. Formulating a well-built question  A major component of evidence-based practice is asking a focused, well-built question. To  perform an effective search of resources, you first need to decide what details are important to the enquiry so that you can formulate the  research question. Wilson et al2 argue that “a well-structured  question will focus [the healthcare provider] on the problem he is most concerned with and will guide his search strategy”, and that learning to ask these questions ensures active, critical thinking.   This article discusses how to formulate a well structured clinical question systematically using an evidence-based model. To make the process of asking an answerable question easier, the Centre for Clinical Effectiveness (CCE) at Monash Institute suggest a framework called “PICO”. Summary points  In order to formulate a good clinical question, you need to:  • Get the question clear in your mind  • Identify the information you need to answer the question  • Translate the question into searchable terms • Develop and refine your search approach using key words  Mid Yorks Medical Journal, Volume 1, Issue 2 Page 28         April 2010  PICO framework  The acronym PICO assists in remembering the steps (P, patient or problem; I, intervention; C, comparison intervention; O, outcomes). A well-built clinical question includes the  following components:    Patient/Population/    Problem  Any characteristics that define your patient or population, e.g. target clinical    condition, co-existing condition, ethnicity, age group.   Intervention/Exposure  What you want to do with the patient/population/problem e.g. form of   treatment, diagnostic test, education programme, type of service delivery.   Comparison/Control    (if applicable)  Alternative(s) to main intervention, e.g. placebo.   Outcomes  Any outcomes or effects relating to the intervention, e.g. prevention,   side  effects, morbidity, quality of life, cost-effectiveness. • Define the type of outcome you wish to  assess. Your question may, for example, pertain to changes in a physical sign or prognostic indicator, the outcome of a  diagnostic test, a response to therapy, or cost effectiveness.  Framing good questions  The following approach can help you frame a good question:  • Describe the subject of the question. It may be helpful to phrase the question in this form: “How would I describe a group of patients similar to this one?”   • Define which intervention you are consider-ing for the specific patient or population; it may be appropriate to name a second inter-vention with which to compare the first. An example of such a pair would be a traditional X-ray versus a magnetic resonance image (MRI).  A worked example   Here is an example question that includes all the four PICO components:   “A patient has just had surgery for breast  cancer. She is feeling fed up and is not  interested in leaving the house.   You wonder whether running or yoga may   be beneficial in giving focus and reviving   her spirits.” Mid Yorks Medical Journal, Volume 1, Issue 2 Page 29         April 2010  The PICO component This can be reworded as follows:   “Does yoga or running help improve quality of life in breast cancer patients?”  Key points  Applying PICO is a systematic way to identify important concepts in a case, and formulate a question for searching. However, you will often not have a comparison intervention. Also,  different types of EBP resources require  different levels of specificity, so depending on the type of resource you’re using, you might not search with all the PICO components at first.   Remember, no matter what type of resource you will ultimately use to look for answers, you should always start by applying PICO to your question so that your approach is strategic from the outset.  What next?  After successfully formulating the clinical ques-tion (step 1), you need to find relevant evidence. You may need to consult several types of infor-mation resources. This will be discussed in the next issue.  Patient/Population/ Problem  Breast cancer  Intervention/Exposure  Running  Comparison/Control   Yoga  Outcomes  Revive spirits References  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it  isn't. British Medical Journal 1996;312(7023):71-2. 2. Wilson K, McGowan J, Guyatt G, Mills EJ, Evidence-based Complementary and Alter-native Medicine Working Group. Teaching  evidence-based complementary and alterna-tive medicine: Asking the questions and identifying the information. Journal of Alter-native & Complementary Medicine 2002;8(4):499-506.  Keen to write a clinical review on a topic that interests you?  Have you completed an audit and wish to get it published?  Have you conducted research and feel that it could educate fellow trainees?  If you are interested in sub-mitting articles and obtaining a peer-reviewed publication then e-mail   MYmedicaljournal@midyorks.nhs.uk  for more information.  Do you disagree with the information in the case reports? Have the prescribing tips or research advice helped you? Let us know and we may print your comments in the next edition. 

Evidence- based practice: formulating a well-built clinical question

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Evidence- based practice: formulating a well-built clinical question

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