Formulating Research Questions · focussed research questions to guide your research. Try and formulate one such question. School of Health Sciences and Social Work Scenario 4

School of Health Sciences and Social Work

Formulating Research Questions


EBP steps

• Formulate a clinically relevant and “answerable” question

• Find the best evidence

• Evaluate the evidence

• Integrate with clinical expertise and patient values and apply to your patient

• Evaluate your performance


Aims of this Step

• To learn how to define an answerable research question

• To gain an understanding of the different types of clinical questions you may ask

• To be able to translate ideas from your workplace into well-defined questions


Benefits of a Clearly Defined Research Question

• Helps to clarify the problem in your own mind

• Can help you to search for the kind of evidence you need to answer it

• Will help you to search more effectively

• Can save you a great deal of search time


Forming an Answerable Question (PICO/PECO)

Break the question down into parts:

• Population

• Intervention/Exposure

• Comparison

• Outcome


PICO/PECO

Component Key step Example

Patient

Problem

population

How would I succinctly

describe a group of similar

patients?

In children under 12

years with condition

x…

Intervention /

Exposure

(test, treatment,

process of care)

What is the main action I

am considering?

… would adding drug Y

to their current

therapy…

Comparison

or alternative

What is/are the other

option(s)?

…compared to

increasing the dose of

their current therapy…

Outcome What do I/the patients want

or not want to happen?

…lead to increased

control with no increase

in side effects?


Population

• Try to be as specific as possible.

• Make sure you are describing the patients or problem that you are interested in.

• This may be too specific when searching, but it is a good start point.


Population

Factors that might need to be considered:

• Disease or condition of interest

• Age

• Sex

• Suffering similar symptoms

• Setting


Intervention or Exposure?

• An intervention is something planned to be “done” to be a patient/client

• Exposure occurs when the patient/client comes into contact with something e.g. exposure to a smoky atmosphere.

• Exposure is usually naturally occurring


Intervention/Exposure

These may include:

• Treatment regime

• Diagnostic test

• Specific risk factors

• Differing environments/settings

• Advice or information package


Intervention/Exposure

• Try to be as specific as possible with the intervention at this stage

• You can always back track later if you can’t find any evidence


Comparison

What is/are the other options or alternatives that could be offered to the patient/client?

• You may compare two or more groups

• One is often known as the control group

• The other group can be another treatment group

• The other group can be current practice


Outcomes

Identify the outcomes that are of primary importance to you and the patient/client e.g.

• Survival

• Disease

• Quality of life


Activity

• Try to identify the individual PICO / PECO components for each of the following scenarios.

And

• Formulate a research question for each scenario.


Scenario 1

A 40 year old woman visits her GP complaining of moderate depression. She has experienced bouts of depression in the past and was prescribed a traditional antidepressant which she feels was helpful. However, she experienced some unpleasant side effects with the drug she was prescribed. She has recently been told by a friend about the use of St John’s Wort in treating depression and feels she would like to try this in treating her current depression.


Scenario 2

A 35-year-old man is recovering from surgery after injuring his hand while cleaning the blades of his lawnmower. He holds a managerial position with a local manufacturer, working to some very short deadlines, and his injury could not have come at a worst time. He needs his hand to be fully functioning, but is concerned that the time he may have to spend in rehabilitation will have a negative effect on his business. The physiotherapist believes that a favourable outcome would be best achieved through early physiotherapy management of his hand, but needs to convince him that such an investment of his time is likely to prove effective.

(Adapted from Booth and Madge, 1998)


Scenario 3

You are a member of a research team interested in the long term consequences on children of living in a family where domestic violence occurs. You are keen to formulate a set of focussed research questions to guide your research. Try and formulate one such question.


Scenario 4

You are a member of a regional Tobacco Strategy Group. The group is considering what support it gives – and should give – people who want to stop smoking. General practitioners have previously been holding a smoking cessation clinic and a Health Promotion nurse offers individual support. A debate follows about the place of nicotine replacement therapy (NRT). Some people argue that it is useful, others that will-power is enough. One suggestion could be to spend savings within general practices on supplying people with nicotine replacement therapy on prescription but there is some resistance to this approach. You want to find out whether NRT is effective.


Scenario 1 – Example response

P 40 year old woman with moderate depression

I St John’s wort

C Prozac

O Depressive symptoms and side effects

Question:

For a 40 year old female with moderate depression, what is the efficacy and tolerability of St John’s wort compared to Prozac?



P 35 year old male with hand injury that has undergone surgical repair

I Early physiotherapy C Other forms of physiotherapy O full restoration of hand functioning Question: In a 35-year old male patient, not a manual worker, with a

hand injury that has undergone surgical repair, does early physiotherapy management of the hand, when compared with other forms of physiotherapy management, lead to full restoration of the hand?



P Children aged 16 years

E Living in a family where domestic violence occurs

C Living in a family where domestic violence does not occur

O Educational attainment

Question: Is living in a family where domestic violence occurs

associated with reduced educational attainment in children aged 16 years?



P Smokers who want to stop smoking

I Nicotine Replacement Therapy

C Other support

O Smoking cessation

Question:

For smokers who want to stop smoking, does nicotine replacement therapy, when compared with patients relying on other means of support, increase their chance of giving up smoking?


PICO/PECO

• May not always be appropriate to specify an intervention, but population and outcomes can usually be identified.

• For complex problems, it will be necessary to map out all component parts and ask a series of questions.


SPICE

• S Setting In which context are you addressing the question?

• P Perspective Who are the participants?

• I Intervention What is being done to/for them?

• C Comparison What are your alternatives?

• E Evaluation How will you measure whether the intervention has succeeded?

An alternative framework to consider when the building a relevant question is using SPICE.


SPICE Scenario

You are working on an ESRC funded project looking at the benefits of a doula (a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth) for low income mothers.


SPICE example

• Setting – the developed world (with comparable health systems to the UK)

• Population – low income mothers • Intervention – Doula • Comparison – Professional support (or no

support) • Evaluation–Perceived levels of social

support, birth outcomes, levels of breastfeeding etc.


Another SPICE Scenario

You are a Health Psychologist wanting to study the psychological problems encountered by people preparing for heart surgery.

Have a go at formulating a set of SPICE components


SPICE example

• Setting - Awaiting surgery

• Population - Patients

• Intervention – Coronary Artery Bypass Graft Surgery

• Comparison – None

• Evaluation – Uncertainty and Anxiety


Broad or Narrow Questions?

• Broad

– Do complimentary therapies work in the treatment of psychological disorders?

• Narrow

– Is St John’s wort effective in treating moderate depression in females aged 30-40 years?


Types of Clinical Questions


Types of Research Question

• Effectiveness

• Causal

• Incidence/Prevalence

• Screening

• Diagnostic

• Prognosis

• Cost-effectiveness

• Psycho-social


Effectiveness Questions

These usually evaluate methods of treatment

E.g. Is radical surgery better (more effective) than conservative surgery in treatment of breast cancer?


Causal Questions

These determine the cause of a disease or adverse effects caused by specific treatments

E.g. What are the underlying factors that cause lung cancer?


Incidence/Prevalence Questions

These determine population prevalence/incidence of disease or characteristics of a disease etc.

E.g. How many woman have cervical cancer(prevalence)?

How many new cases of dementia in the elderly were recorded last year (incidence)?


Screening Questions

Where a specific screening programme is evaluated

E.g. Does cervical screening reduce deaths?


Diagnostic Questions

Where different types of tests are evaluated

E.g. How effective is the nuchal translucency scan in

detecting foetuses with chromosomal abnormities?


Prognosis Questions

These estimate the likely progress of the patient/client's condition

E.g. If you sprain your ankle playing sport are you more likely to have a recurrent sprains / unstable ankles?


Cost-effectiveness Questions

Where the economics of health care is evaluated:

E.g. Is a short term (expensive) course of drugs for ulcers better than a long term (cheaper) course of drugs, knowing that the short term course of drugs is slightly more effective?


Psycho-social Questions

Where knowledge, attitude and behaviour patterns are associated with psycho-social factors:

E.g. Do patients prefer to be involved in decision-making about their treatment?


Generating Your Own Research Questions


Generating Questions

Questions you ask may arise from:

• Your individual professional work

• A group initiative

• A topical issue

• A national initiative

• A professional desire

• A patient/client’s query


Problems relevant to a range of practitioners

• Needing help in diagnosing a particular condition

• Needing to find out more about the benefits and possible adverse effects of a particular intervention

• Audit results showing poor outcomes

• A prominent issue is taken up by the media and causes concern to service users

• Comparing the costs and benefits of different therapies

• Patients/clients ask about a treatment of which you do not know the answer


Steps to Building a Focused Question

• Jot down ideas as they occur.

• Examine later and see whether you need to spend time exploring further.

• Take time to refine your question using the PICO / PECO formula.

• Consider various possible alternative outcomes or interventions.

• Include the alternatives when performing your

searches. • Decide what type of clinical question you are

asking.

Documents

Formulating Research Questions · focussed research questions to guide your research. Try and formulate one such question. School of Health Sciences and Social Work Scenario 4