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.
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.
| P | Patient, population, problem |
|---|---|
| I | Intervention, exposure, or prognosis factor |
| C | Comparison or comparator |
| O | Outcome |
| T | Type of question Are you looking at diagnosis, harm, prevention, prognosis, therapy? |
|---|---|
| T | Timeframe Are you looking for results and problems occuring at a particular point in time or for a specified amount of time? |
What are some examples of P?
What are some examples of I?
What are some examples of C?
What are some examples of O?
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.
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