Framing a Research Question – Critical Thinking and Evidence Based Medicine (EBM)

00:01 Okay, now we're going to ask the research question. This seems like it should be a straightforward easy thing to do, but professionals who conduct systematic reviews or do EBM searches will spend a great amount of time focusing on phrasing the question as precisely as possible. The more focused and precise the phraseology, the more correct and targeted the result of the search will be. There are many ways to phrase a research question correctly, I like to use a method called the PICO method, and those letters stand for certain things. The P stands for patient population, so who's your patient population, who is your patient, what are his or her needs or cohorts? The I stands for interventions, what action are you considering? The C stands for a comparison or a control group, what are you comparing them to? And lastly the O is outcome, what is it that you're trying to change or accomplish? What's the disease state you're measuring? So there are many different kinds of questions we can be asking as well, there are at least four, one of them is therapeutic. Maybe you want to know what treatments are available that lead to certain kinds of outcomes for your patient.

01:14 Maybe you want to know about how best diagnose a patient's condition. Maybe you want to know about how likely is the patient going to have certain kinds of outcomes, their prognosis or maybe you want to know what's the relationship between the disease and its possible cause, in other words a measurement of harm. So let's do an example, a doctor wants to research the effects of dietary fat on breast cancer risk, maybe this doctor has a middle-aged female patient who has a family history of breast cancer and she wants to minimize her risk in all possible ways going forward, because she knows it's in her family history, so she knows about the genetic portion of breast cancer, now she wants to know a little bit more about the behavioral aspects of breast cancer and she wants to know whether removing dietary fat from her behavior will gain her any kind of advantage going forward in not acquiring breast cancer like her mother did. So what do you do? You're going to search the literature; you're going to employ EBM methods to do so. You do so by phrasing an appropriate question. Let's use the PICO method. Patient population, well it's going to be adult woman, because your patient is an adult woman, the intervention you care about is dietary fat, that's the thing that's going to make the change. The comparison group you care about, well there isn't really one, we're comparing adult women to themselves really and the outcome we care about is breast cancer. Note that the comparison group here is empty, that's quite common, the PICO method has some flexibility to it. The type of question you are asking is an etiologic one, you're looking for relationships between exposures and outcomes, that's relevant when you're looking through the studies that you find to see what their focus is, is your focus a description, is it etiologic, is it behavioral, is it opinion? And you will take any kind of study at this point, even though you know, at the end of the day, you are going to apply the evidence pyramid and try to pick the best quality evidence.

03:14 So here's your question then, 'In adult women, is dietary fat a risk factor for breast cancer?” That's the PICO outcome. Now you may think that you could've gotten that answer yourself without going through the PICO process and that's fine, but some people need a framework to help them phrase these kinds of questions.

03:32 So what do you do now? You actually apply the search. There are lots of search engines you could go to, so one of them is pub med and that's a free search engine run by the American government, that you can type in the appropriate keywords, 'dietary fat treatment'.

03:48 You can go to Google scholar and type in keywords as well, there are literally scores of possible search engines to try, world science for example.