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Nursing

Narrowing a Clinical Question

To begin to develop and narrow a clinical research question it is advisable to craft an answerable question that begins and ends with a patient, population, or problem. These are the beginnings of not only developing an answerable EBP question, but also using the PICO process for developing well-built searchable and answerable clinical questions. 

Two Types of Clinical Questions

There are many elements to developing a good clinical question. Clinical questions can be further divided into two major areas: Background Questions and Foreground Questions.

Background Questions refer to general knowledge and facts. The majority of the information that can be used to inform answers to background questions are found in reference resources like Encyclopedias, Dictionaries, Textbooks, Atlases, Almanacs, Government Publications & Statistical Information, and Indexes.

Foreground Questions are generally more precise and usually revolve around patient/s, populations, or a specific problem. Crafting an appropriate EBP question will not only inform your search strategy which you will apply to the medical literature but will also create a framework for how to maintain and develop your investigative process.

What is PICO Anyway?

P Patient, population, problem
I Intervention, exposure, or prognosis factor
C Comparison or comparator
O Outcome

PICOTT Alternatives and Additions

Type of question
Are you looking at diagnosis, harm, prevention, prognosis, therapy?
Timeframe
Are you looking for results and problems occuring at a particular point in time or for a specified amount of time?

PICO Process in Action

What are some examples of P?

  • Diabetes mellitus, Type 2 (problem) Obese
  • elderly (population)

What are some examples of I?

  • Chlorpropamide

What are some examples of C?

  • Metformin

What are some examples of O?

  • Management of glucose levels

Using PICO to Form the Research Question

Using the example from the bottom-center we can start forming a research question: 

Is Chlorpropamide (intevention) more efficient than Metformin (comparator) in managing Diabetes Mellitus Type 2 (problem) for obese elderly patients (population)?

*Note: It is not necessary to use every element in PICO or to have both a problem and population in your question. PICO is a tool that helps researchers frame an answerable EBP question. 

Tips and Tricks

Synonyms can very helpful throughout your investigative and research process. Using synonyms with boolean operators can potentially expand your search. Databases with subject headings or controlled vocabularies like MeSH in PubMed often have a thesaurus that can match you with appropriate terms.

Elderly Geriatrics, Aged
Heart Attack Myocardial Infarction

Boolean operators allow you to manipulate your search.

Use AND to narrow your search

  eg. elderly AND diabetes 

Use OR to broaden your search

  eg. myocardial infarction OR heart attack

Use NOT to exclude terms from your search

  eg. children NOT infants