A well-structured question helps you to define the focus of the project or need. It also defines the boundaries to guide your search for evidence.
In EBP the need to identify research evidence begins with a problem or issue relating to a patient, population, or service. From this, formulating a question that can be answered is a critical step. It influences where you search for evidence and the type of research studies that can provide you with useful evidence. There are frameworks available to help you with this task. Before selecting a framework to guide development of your question it can help to first identify the type of question you have.
Specific questions that support clinical decision-making might be referred to as foreground questions.  This question form often includes elements that reflect the patient situation, context, population, problem or phenomenon of interest, as well as the intervention, comparator, and clinical outcomes of interest.
It is also important to understand the type of question being asked. Is it about treatment, diagnosis, prognosis, aetiology, other? The answer to this will influence the most suitable type of research study design for investigating or answering the question.  It will also determine the most appropriate question framework to use.
Question frameworks (mnemonics) help you formulate questions to guide your search for evidence.  Each framework term aims to define characteristics of your question. The PICO framework is often used for developing questions about clinical interventions but there are others. For qualitative questions PICo or SPIDER might be selected.
Combining terms used across a range of question frameworks yields at least 10 categories that might be considered when formulating a question (see box). What you use will be influenced by the form and type of your question.
P – Population
I – Intervention or exposure
C - Comparison
O - Outcome
Co - Context or environment or setting
P – Professionals
R – Research question or study type
S – Stakeholder or perspective or potential users
Not all elements will be relevant to all questions. Choose the framework that suits your question. The framework is a guide to prompt you to consider what is important and to focus the question. Simply respond to as many elements as you can and then use this to define your question.
When using these elements to develop your question remain neutral and avoid value judgements and questions that have a premise or suggest an answer. For example, Why is morphine better than music therapy for people with advanced cancer? - implies that morphine is always preferable. Alternatively, What is the benefit of music therapy for pain in people with advanced cancer?, or What are the reasons that people with advanced cancer ask for music to control pain? are more neutral questions that are likely to give more useful information.
CareSearch has a range of interactive forms for some of the commonly used question frameworks. Here you can download these to assist with developing your question.
Video from The University of Sydney
The National Institute for Clinical Excellence (NICE) has examples of
research questions in the palliative care context including the
Scenario: Recognising that a person is dying is challenging but minimising the uncertainty allows for discussions to take place between health professionals and the dying person and those important to them. Since prognostic tools and models currently have limited accuracy the potential impact of multidisciplinary team approaches to reducing uncertainty through communication and shared-decision making is important to understand. To investigate evidence-based approaches to this we might use PICO to help us develop a specific question that can be answered.
P = person with a life-limiting illness and potentially being in the last weeks of life
I = various multidisciplinary team interventions including different methods for giving feedback, initiating end of life discussions, record keeping or updating care plans for the purpose of recognising and acting on signs of dying
C = usual care or practice
O = quality of life for the patient or carer satisfaction, changes to clinical care, identification and achievement of a person's goals and wishes
What can multidisciplinary teams do to reduce the impact of uncertainty of recognising when a person is entering the last days of life?
To compare multidisciplinary team interventions using QoL or satisfaction measures to assess and quantify outcomes.
Interview health professionals, the patient and family to explore barriers and facilitators to reducing the impact of uncertainty around recognising death on good clinical care, shared decision making and communication.
Page created 28 March 2022