Search Basics for the Health Sciences: Focusing the Question

Figuring out what question you are asking--whether it is part of a research and writing assignment or arising within a clinical practice setting--is one of the hardest parts of the searching process. While some questions take an obvious form, such as 'why does my patient have numbness in her legs?', more often, questions arise from problems that have to separated out from a lot of contextual information. Whether the question is easily identifiable or the question takes a little effort to identify, framing your information need as a question is critical to being able to find the information necessary to answer the question and resolve the problem. 

Example 1: Paper for a Course: Argument paper on Ethics in Health Care

While you are in school, you may feel that having to write a paper to fulfill an assignment is the primary problem. However, you ultimately have to write the paper, and once you select the topic or perspective you will write about (which may require help from your professor if you're having trouble choosing a topic), you have to frame the topic area as a problem and then phrase your problem as a question (Booth, 2008). This means going from the broad (the topic) to the specific (the question). Below is an example.

• topic choice: caring for patients with dementia
• problem: Nurses, physicians, and other health practitioners encounter patients with dementia in many different settings, and have to respect the patient's autonomy while providing the highest quality of care, which means making decisions to ensure the quality of life and well-being of the patient. Since dimentia involves progressive cognitive decline, often, the patient's family or guardian begins to take on the role of decision-making, putting the nurse/physician/health practitioner in a position of needing to consider the family's or guardian's perspectives as well. At times, the patient's wishes and the family or guardian's wishes may be at odds. (Daly & Fahey-McCarthy 2014; Kim et al., 2009; Woods & Pratt, 2005)
• question: How does a health professional balance respect for the patient with dementia's autonomy and right to involvement in decision-making about their health with the demands and wishes of family members or other legal guardians?

In this example, if it were for an argument paper, you would need to take a stance on the topic. However, the important step of deciding on the question would be completed.

Example 2: Clinical Problem

Clinical problems arise naturally from the context of care. They are generally problems that are specific to a single patient or that arise from long-term observation of patients. Below is one example of a clinical 'problem' that you identify from long-term observation.

• problem: You have Caesarean section patients who either receive surgical staples or subcuticular sutures. At follow-up visits, patients talk to you or ask you about surgical wound pain, healing rates, and the scar visibility in the future. From regular conversations about these aspects of post-caesarean section surgical wounds, you wonder if the concerns and satisfaction of patients differ depending on the type of surgical wound closure. 
• question: How does the type of surgical wound closure material after caesarean sections affect patient satisfaction?

Clinical patient care and practice questions can and should be broken down into essential components to make the information-seeking process easier. While it is tempting to type out your research or clinical questions the same way that you would verbalize them in a conversation--such as typing 'how do you/i' or 'what is' into a search bar--with research questions, it is not effective, and within databases, very likely to result in poor searches.

In the health sciences, the most common way to begin breaking apart a question is to use the PICO(T) format, which breaks a question apart according to:

P – Patient, population, problem, and/or phenomenon
I – Intervention or Exposure
C – Comparison (optional)
O – Outcome (optional)
T – Time (optional)

In essence, using the PICO format, you turn your question into a set of simple descriptors that you can use to search for research reports and articles that will answer your question. Although the process of breaking a question apart using PICO(T) is described here as a way to more effectively search for research to answer your question, the PICO(T) method also helps you focus your question further.

Keep in mind that:

• You do not need every part of the PICO formula; for some questions, you will not have a comparison, a time factor, and sometimes not even an intervention. For example, if you are interested in how human error affects patient safety, you have neither intervention, comparison, or time. See Example 1 below for demonstration of a question with nothing but the P of PICO(T)
• When actually entering your search terms, you never actually search for the O--outcome--you merely use your 'Outcome' as your assessment of whether or not the article answers your question.

Example 1 in PICO(T):
Question: How does a nurse/physician/health professional balance respect for the patient with dementia's autonomy and right to involvement in decision-making about their health with the demands and wishes of family members or other legal guardians?

P: 

Population 1: patients with dimentia
Population 2: caregivers or legal guardians (or family members or proxies)
Phenomenon 1: personal autonomy
Phenomenon 2: decision-making

Example 2 in PICO(T):
Question: How does the type of surgical wound closure (sutures or staples) material after caesarean sections affect patient satisfaction?

P:   Population: Caesarean section
      Phenomena: pain, healing rate, discomfort (parts of patient satisfaction)
I: sutures
C: surgical staples
O: satisfaction