Chapter 2 Asking Compelling Clinical Questions Copyright 2011

Barriers to Finding the Right Information at the Right Time Lack of proficiency in

Types of Questions to Develop Prior to Beginning a Literature Search Background questions •

Types of Questions to Develop Prior to Beginning a Literature Search—(cont. ) Foreground questions

Question Is the following statement true or false? Foreground questions can often be answered

Answer False Rationale: Foreground questions are clinical questions that can only be answered by

Types of Questions to Develop Prior to Beginning a Literature Search—(cont. ) Types of

Question Is the following statement true or false? A well-formulated PICOT question should specify

Answer True Rationale: A PICOT question should always specify the outcome that is expected

Asking Foreground Questions Using the PICOT Format P: Population of interest I: Intervention or

PICOT Format: Intervention Template In ________(P) how does______(I) compared to _____(C) affect ______(O) within

PICOT Format: Prognosis Template In ________(P) how does______(I) compared to _____(C) influence/predict _______(O) over

PICOT Format: Diagnosis Template In ________(P) is ______(I) compared to _____(C) more accurate in

PICOT Format: Etiology Template Are ________(P) who have _____(I) compared to those without _________(C)

PICOT Format: Meaning Template How do ________(P) with _____(I) perceive _________(O) during ______(T)? Copyright

Question Which of the following components of a PICOT question is absent from the

Answer d. T (Time) Rationale: This question specifies the patient population (patients with dementia),

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Barriers to Finding the Right Information at the Right Time Lack of proficiency in using computers Lack of computer access at point of care Low comfort level/lack of skill using search techniques Lack of access to appropriate electronic databases Lack of time to search for the best evidence Copyright © 2015 Wolters Kluwer • All Rights Reserved

Types of Questions to Develop Prior to Beginning a Literature Search Background questions • Asks for general information about a clinical issue • Usually has two components: o o • 1. The starting place of the question (e. g. , what, where, when, why, and how) 2. The outcome of interest Broader in scope than a foreground (PICOT) question Example: “How does the drug acetaminophen work to affect fever? ” Copyright © 2015 Wolters Kluwer • All Rights Reserved

Types of Questions to Develop Prior to Beginning a Literature Search—(cont. ) Foreground questions (PICOT format) • • • Asks for specific scientific evidence about diagnosing, treating, or educating patients The focus is on specific knowledge Use of PICOT format is recommended for a focused literature search Example: “In children aged 3 to 8 years, how does acetaminophen compare with ibuprofen in lowering a fever? ” Copyright © 2015 Wolters Kluwer • All Rights Reserved

Question Is the following statement true or false? Foreground questions can often be answered by consulting an up-to-date nursing or science textbook. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Answer False Rationale: Foreground questions are clinical questions that can only be answered by specific scientific evidence that is usually found in original studies or systematic reviews of original studies (e. g. , RCTs). This type of evidence is not available in textbooks, which are more appropriate for answering background questions. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Types of Questions to Develop Prior to Beginning a Literature Search—(cont. ) Types of foreground questions • Intervention questions (What intervention most effectively leads to an outcome? ) • Prognosis/prediction questions (What indicators are most predictive of an outcome? ) • Diagnosis questions (What test most accurately diagnoses an outcome? ) • Etiology questions (To what extent is a factor associated with an outcome? ) • Meaning questions (How does an experience influence an outcome? ) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Question Is the following statement true or false? A well-formulated PICOT question should specify the measurable patient outcomes that need to addressed. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Answer True Rationale: A PICOT question should always specify the outcome that is expected from the clinical question. It is important that the outcome be measurable in some way so that the effectiveness of the change can be evaluated. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Asking Foreground Questions Using the PICOT Format P: Population of interest I: Intervention or issue of interest C: Comparison of interest O: Outcome expected T: Time needed for the intervention to achieve the outcome or the time in the course of the disease/symptom that the intervention is applied Copyright © 2015 Wolters Kluwer • All Rights Reserved

PICOT Format: Etiology Template Are ________(P) who have _____(I) compared to those without _________(C) at _______ risk for/of ______ (O) over ______(T)? Copyright © 2015 Wolters Kluwer • All Rights Reserved

Question Which of the following components of a PICOT question is absent from the following clinical question? “Among patients with dementia, how does the use of reorientation therapy compared with regular, supervised mobility affect patient agitation? ” a. P (Population) b. I (Intervention) c. O (Outcome) d. T (Time) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Answer d. T (Time) Rationale: This question specifies the patient population (patients with dementia), the intervention (reorientation therapy), the comparison (regular, supervised mobility), and the relevant outcome (patient agitation), but does not provide the time frame for an expected outcome. Copyright © 2015 Wolters Kluwer • All Rights Reserved