Help and Support: Evidence-Based Practice: Ask

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The first step in evidence-based practice is to define your clinical question. The question guides the rest of the process. This includes determining inclusion and exclusion criteria, developing the search strategy, collecting data, and presenting findings.

A good review question:

allows you to find information quickly
allows you to find relevant information (applicable to the patient) and valid (accurately measures stated objectives)
provides a checklist for the main concepts to be included in your search strategy.

Developing a well-formulated question is critical to successfully undertaking evidence-based practice.

Question Frameworks

Using a question framework in your research is crucial because it provides a clear, structured, and focused approach to formulating research questions and guides the entire research process from literature search to critical appraisal. This helps ensure that research is relevant, high-quality, and directly applicable to clinical or decision-making contexts.

Stay focused on a specific research question.
Make sure your question is relevant to the real-world situation.
Create a structure for your research.
Find the right information during your search.
Assess the quality of the evidence you find.
Think critically about the evidence.
Be consistent in your approach.
Use the evidence to make informed decisions.
Keep track of your research process.

The PICO framework is favoured for developing focused clinical questions because it provides a structured and clear way to define the key components of a question, ensuring specificity, relevance, and applicability to clinical practice. This makes it a valuable tool for guiding the research process.

PICO for quantitative studies

P	I	C	O
Population/Patient/Problem	Intervention or Exposure	Comparison or Control	Outcome
What are the characteristics of the Population or Patient? What is the Problem, condition or disease you are interested in?	How do you wish to Intervene? What do you want to do with this patient - treat, diagnose, observe, etc.?	What is the Comparison or alternative to the intervention - placebo, different drug or therapy, surgery, etc.?	What are the possible Outcomes - morbidity, death, complications, etc.?

Population/Patient/Problem

Intervention or Exposure

Comparison or Control

Outcome

What are the characteristics of the Population or Patient?

What is the Problem, condition or disease you are interested in?

How do you wish to Intervene? What do you want to do with this patient - treat, diagnose, observe, etc.?

What is the Comparison or alternative to the intervention - placebo, different drug or therapy, surgery, etc.?

What are the possible Outcomes - morbidity, death, complications, etc.?

Here is an example of a clinical question that outlines the PICO components:

P: In middle aged, male amputees suffering phantom limb pain; I: is gabapentin; C: compared with placebo; O: effective in decreasing pain symptoms?

PICO worksheet

This modified version of the PICO framework is more suitable for qualitative studies. The "Interest" and "Context" components are essential for framing a research question that captures the unique aspects of qualitative inquiry. This PICo framework helps researchers develop more contextually rich and relevant questions that align with the goals of qualitative research, which often involve exploring experiences, perspectives, and social or cultural contexts.

PICo for qualitative studies

P	I	Co
Population/Patient/Problem	Interest	Context
What are the characteristics of the Population or Patient? What is the Problem, condition or disease you are interested in?	Interest relates to a defined event, activity, experience or process	Context is the setting or distinct characteristics

Population/Patient/Problem

Interest

Context

What are the characteristics of the Population or Patient?

What is the Problem, condition or disease you are interested in?

Interest relates to a defined event, activity, experience or process

Context is the setting or distinct characteristics

Here is an example of a clinical question that outlines the PICo components:

P: What are caregivers, providing home based care to patients with Alzheimer's disease; I: experiences in; Co: Australia.

PICo worksheet

Two other mnemonics may be used to frame questions for qualitative and quantitative studies - SPIDER and SPICE.

SPIDER for qualitative or quantitative studies

SPIDER can be used for both qualitative and quantitative studies:

S	PI	D	E	R
Sample	Phenomenon of Interest	Design	Evaluation	Research type
Sample size may vary in quantitative and qualitative studies	Phenomena of Interest include behaviours, experiences, and interventions	Design influences the strength of the study analysis and findings	Evaluation outcomes may include more subjective outcomes such as views, attitudes, etc.	Research types include qualitative, quantitative, or mixed-method studies

SPICE

Within social sciences research, SPICE may be more appropriate for formulating research questions:

S	P	I	C	E
Setting	Perspective	Intervention	Comparison	Evaluation
Setting is the context for the question - where	Perspective is the users, potential users or stakeholders of the service - for whom	Intervention is the action taken for the users, potential users or stakeholders - what	Comparison is the alternative actions or outcomes - *what else*	Evaluation is the result or measurement that will determine the success of the intervention - what result or *how well*