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Evidence Based Nursing: Creating an Answerable Question

Creating an Answerable Question

Refining and creating a well-built EBP question is often the most difficult task in the PET process. Determining what information to search for is imperative when stating the practice question (Dearholt, 24). 

Background & Foreground Questions

When forming a question out of the practice problem, consider how the pieces of unknown information relate to one another. Background Questions concern general knowledge like understanding the broad characteristics of a disease or treatment. Foreground Questions often emerge from background Questions. Foreground questions take specific knowledge from a background question area and ask for specific information to help make decisions (Straus, 15). 

Asks Components Examples
Background Questions asks for general knowledge about a condition, test, or treatment. 
  • question root: (who, what, where, when, how, why) and a verb. 
  • An aspect of healthcare like a test, disorder, or treatment. 
  • How are Type 1 and Type 2 Diabetes different? 
  • What is the screening process for breast cancer? 
Foreground Questions Asks for specific knowledge to inform clinical decisions actions. 
  • P = patient, population, problem
  • I = intervention, exposure, or test. 
  • C = comparison intervention , exposure or test. 
  • O = Important clinical outcomes. 

* Note that not all PICO parts will be active or applicable when asking the question. 

"In American adolescents, does clinical prescription of opioids prior to high school graduation pre-dispose those individuals to opioid misuse/abuse in adulthood?"

*Dearholt & Dang, 2012

Research or Non-Research?

Qualitative Quantitative
How and why interventions work or don’t work.  Effectiveness of interventions
Multiple Perspectives One True Answer
Doesn’t try to disrupt the environment Tries to introduce new changes to the environment. 
May include quotes

Personal context isn’t emphasized

* Information found at National Collaborating Centre for Methods and Tools. 

Defining the Question Type

Type of Question Def. Study PICO Template PICO example
Therapy Deciding if a treatment's pros outweigh the cons. Systematic Review/Meta-analysis → RCT → Case Control → Case Series "In _P_ do/does _I_ result in _O_ when compared with _C_ over _T_?" In Healthy Full-term newborns who are undergoing a painful procedure , does sucrose combined with radiant warmth result in lessened pain during a painful procedure when compared with using only sucrose?
Diagnoses How to evaluate and analyze diagnostic tests. Cross-Sectional → Prospective, Blind comparison to Gold Standard Is/are _I_ performed on_P_ more effective than _C_ over _T_in _O_? "Are self-reporting interviews and parent reports performed on children aged 5-10 more effective than parent reports alone over a four-week consultation process in diagnosing depression?"
Etiology How to determine a cause for disease. Systematic Review/Meta-analysis → RCT → Cohort Study → Case Control → Case Report Are _P_ with _I_ over _T_ more likely to _O_ when compared with _C_ ? In early chilhood, does  Hand dishwashing result in fewer or More Allergic Disease developments when compared with Machine Dishwashing in Children aged 7-8 years?
Prognosis How to estimate and anticipate a patient's likely course of disease or treatment, excluding intervention factors named in PICO. Cohort Study → Case Control → Case Series Do/does _I_ performed on _P_ lead to _O_ over _T_compared with _C_?

does location of suture fusion  in school aged children with single- suture-craniosynostosis lead to developmental delays when compared with unaffected children or children with different suture locations?
Prevention How to anticipate and correct barries to a patient's health. RCT → Cohort Study → Case Control In _P_, do/does _I_ result in _O_ when compared with _C_ over _T_? "In emergency room visitors, do hand sanitizing stations result in fewer in-hospital infections when compared with no hand sanitizing stations over a year-long pilot period?"

*PICO template examples found at http://hsl.mcmaster.libguides.com/ebm