Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2: Asking Compelling, Clinical Questions

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Finding the Right Information at the Right Time  The key to successful patient care for any healthcare professional is to stay informed and as up-to-date as possible on the latest best practices  Skills are required to negotiate the information-rich environment

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Asking Clinical Questions: PICOT Format  P: Population of interest  I: Intervention or issue of interest  C: Comparison of interest  O: Outcome expected  T: Time for the intervention to achieve the outcome

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question  Tell whether the following statement is true or false.  A well-formulated PICOT question should specify the patient outcome that the question will address.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer  True  Rationale: A PICOT question should specify the outcome that is expected from the clinical question.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Haystack: Too Much Information  News of clinical advances often diffuses slowly through the literature  Only a small percentage of clinicians access and use the information in a timely fashion  The EBP process focuses on incorporating good information-seeking habits into a daily routine  Skill at managing electronic resources is essential

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Two Types of Questions  Background questions  Ask for general information about a clinical issue  Specify the staring point and the outcome of interest  Foreground questions  Can be answered from scientific evidence about diagnosing, treating, or assisting patients with understanding their prognosis  Focus on specific knowledge

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question  Tell whether the following statement is true or false.  Foreground questions can often be answered by consulting an up-to-date nursing or science textbook

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer  False  Rationale: Foreground questions are the frequently complex and specific clinical questions, which are answered by consulting rigorous evidence. This evidence is not typically available in textbooks, which are more appropriate for answering background questions.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Inquiry  An outcome of uncertainty  Defined as a process in which clinicians gather data together using narrowly defined clinical parameters to appraise the available choices of treatment for the purpose of finding the most appropriate choice of action

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Foreground Questions  Intervention questions  Prognosis/prediction questions  Diagnosis questions  Etiology questions  Meaning questions

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question  Which of the following components of a PICOT question is absent from this clinical question? “Among patients with dementia, how does use of reorientation therapy compared to regular, supervised mobility affect patient agitation?” a.P b.I c.O d.T

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer  d. T  Rationale: This question specifies the patient population, the intervention, the comparison, and the relevant outcome, but does not provide a time frame.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Why Work Hard at Formulating a Question?  It focuses your search, saving time and energy  Other benefits of clear questions  Clearly communicating patient information with colleagues  Helps learners more clearly understand content taught Practice, Practice, Practice!