Asking Focused Questions
One of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients’ problems and phrased in ways that direct your search to relevant and precise answers. In practice, well-built clinical questions usually contain four elements, summarised below.
|Patient or Problem||Intervention|
(a cause, prognostic factor, treatment, etc.)
|Tips for Building||Starting with your patient, ask “How would I describe a group of patients similar to mine?”|
Balance precision with brevity.
|Ask “Which main intervention am I considering?”Be specific.||Ask “What is the main alternative to compare with the intervention?”Again, be specific.||Ask “What can I hope to accomplish?” or “What could this exposure really affect?”Again, be specific.|
|Example||“In patients with heart failure from dilated cardiomyopathy who are in sinus rhythm …”||“… would adding anticoagulation with warfarin to standard heart failure therapy …”||“… when compared with standard therapy alone …”||“… lead to lower mortality or morbidity from thromboembolism. Is this enough to be worth the increased risk of bleeding?”|
Benefits of asking focused questions
One of the benefits of careful and thoughtful question-forming is that the search for evidence is easier. The well-formed question makes it relatively straightforward to elicit and combine the appropriate terms needed to represent your need for information in the query language of whichever searching service is available to you.
Once you have formed the question using the PICO structure, you can think about what type of question it is you are asking, and therefore what type of research would provide the best answer.