Information Fluency

Clinical questions arise from encounters with patients or problem in the clinical setting. While some clinical questions can be easily answered by consulting a reference guide, some questions are more complex and require you to search for research evidence.

Clarifying the key elements of the clinical question is an important step to frame the question and locate an answer to inform clinical decisions. To build a well-defined clinical question, you'll need to consider the type of foreground question and the most appropriate type of study or methodology that can address the question. It is important to look for the study design that will yield the highest level of evidence in the evidence pyramid.

Background questions:

• general knowledge and foundational information on an illness, disease, diagnostics, procedures, and etc. What? Why? Where? Who? How?

Foreground questions:

• specific knowledge to inform clinical decisions for a particular patient, population, or research topic

The PICO is a mnemonic that captures the key elements to help develop focused clinical questions. It can also be used to formulate the search strategy by identifying key concepts.

• Patient/problem/population: who the relevant individuals are for the problem being addressed
• Intervention: what main intervention is being considered
• Comparison: what is the main alternative or comparator to the intervention that is being assessed
• Outcomes: what is being measured, improved, or affected

For examples of well-defined PICO questions, visit the Cochrane Clinical Answers. The Cochrane Clinical Answers provides evidence-based answers to PICO clinical questions that come across in clinical practice. These answers have been created to inform decision-making at the point of care, and link to Cochrane Reviews that have been filtered to its clinically relevant aspects.

To develop a clinical question, it is important to think about the type of question you have. Here are some common types of clinical questions:

• Diagnosis: questions concerning the ability of a test to predict the likelihood of a disease in order to confirm or exclude a diagnosis
• Therapy: questions concerning the effectiveness of a treatment or preventative measure to offer a patient that is work the effort and cost
• Prognosis: questions concerning an estimate of the clinical course of a condition over time and anticipate likely complications of the disease
• Harm/etiology: questions concerning the causes of the disease including iatrogenic forms
• Prevention: questions concerning differential diagnosis and symptom prevalence
• Cost: questions concerning the cost effectiveness of interventions

Different clinical questions are best answered by different types of research studies. The best available or highest level of evidence to answer your question may not always be available in a systematic review or meta-analysis.