MWU Library: Evidence Based Practice: ASK

Evidence Cycle: Ask an answerable patient care question

When beginning to ask your clinical question, you will need to assess the patient/issue at hand. Here are some steps and questions to help you brainstorm:

Summarize the case. What questions do you have surrounding it?
Of these questions, which are background questions?
- Background questions ask for general knowledge on a disorder and can easily be looked up in a resource like UpToDate.
- Example: What are the complications of bacterial meningitis?
Of these questions, which are foreground questions?
- Asks for specific knowledge about managing patients with disorders.
- Fits into the PICO framework (see below).

Question Types

There are a variety of clinical question types that can be asked. Depending on the type of question you ask, some study types will be more appropriate than others to use as evidence.

Type of Question	Type of Study
Therapy Looking at the effect of an intervention, often compared to a gold standard intervention, no intervention, or a placebo on patient-important outcomes. Will the treatment do more harm than good?	Meta-Analysis Systematic Review Randomized Controlled Trial (RCT)
Prognosis Looking at a patient's likely clinical course over time, such as complications of a disease or condition, due to factors other than interventions.	RCT Cohort Study Case-Control Study
Harm/Etiology If an exposure of potentially harmful agents cause a disease or condition over time.	Case-Control Study Cohort Study
Diagnosis Whether one test is more accurate with differentiating those with and without a targeted disease or condition.	Prospective, blind comparison to a gold standard Cross Sectional
Prevention If a preventative measures to identify and modify risk factors will reduce the chance of disease.	Meta-Analysis Systematic Review RCT

Type of Question

Type of Study

Therapy

Looking at the effect of an intervention, often compared to a gold standard intervention, no intervention, or a placebo on patient-important outcomes.

Will the treatment do more harm than good?

Meta-Analysis

Systematic Review

Randomized Controlled Trial (RCT)

Prognosis

Looking at a patient's likely clinical course over time, such as complications of a disease or condition, due to factors other than interventions.

RCT

Cohort Study

Case-Control Study

Harm/Etiology

If an exposure of potentially harmful agents cause a disease or condition over time.

Case-Control Study

Cohort Study

Diagnosis

Whether one test is more accurate with differentiating those with and without a targeted disease or condition.

Prospective, blind comparison to a gold standard

Cross Sectional

Prevention

If a preventative measures to identify and modify risk factors will reduce the chance of disease.

Meta-Analysis

Systematic Review

RCT

PICO(T) Framework

The PICO(T) model is a framework clinicians use to focus an otherwise vague research topic.

There may be questions that do not use all components of PICO(T).

P	Patient/Problem	How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? Primary problem, disease, co-existing conditions. Sometimes sex, age, or race of the patient could be relevant.
I	Intervention/Prognostic Factor/Exposure	What is the main intervention, prognostic factor, or exposure are you considering or wanting to learn more about? What do you want to accomplish for the patient? What was the patient exposed to?
C	Comparison	Is there a standard treatment or an alternative to what you're considering doing? Is the comparison doing nothing or a placebo? Is there no comparison at all?
O	Outcomes	What are you hoping to accomplish? How will you measure it?
(T)	Time Type of Question Type of Study	Period of time it takes to demonstrate an outcome OR the period of time patients are observed. The question type will often correlate with the best study design to address the question.

Example Case

You have a female patient who has recently been diagnosed with rheumatoid arthritis. Her rheumatologist suggested she start on Plaquenil for her joint pain, but she is interested in alternative therapies because she heard about success a neighbor had with eliminating nightshade vegetables from their diet.

Patient/Problem	Intervention	Comparison	Outcome
Adult with rheumatoid arthritis	Elimination of nightshade vegetables Anti-inflammatory diet	Plaquenil	Reduce joint inflammation and pain.
Final Question In adults with rheumatoid arthritis, does an anti-inflammatory diet such as eliminating nightshade vegetables reduce joint inflammation and pain more effectively than Plaquenil?
Time: N/A Type of Question: Therapy Type of Study: Meta-analysis > Systematic Review > Randomized Controlled Trial (RCT)

Patient/Problem

Intervention

Comparison

Outcome

Adult with rheumatoid arthritis

Elimination of nightshade vegetables

Anti-inflammatory diet

Plaquenil

Reduce joint inflammation and pain.

Final Question

In adults with rheumatoid arthritis, does an anti-inflammatory diet such as eliminating nightshade vegetables reduce joint inflammation and pain more effectively than Plaquenil?

Time: N/A

Type of Question: Therapy

Type of Study: Meta-analysis > Systematic Review > Randomized Controlled Trial (RCT)

Evidence Based Practice: ASK

Evidence Cycle: Ask an answerable patient care question

Question Types

PICO(T) Framework

Example Case

Final Question

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