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Most clinical encounters lead to a need for information. The first step in EBM is to translate the need for information into a question that can be answered by clinical research.
There are "foreground" questions and "background" questions.
- look for general knowledge
- contain a who, what, where, when, or why
- contain a verb
- look at an aspect of health care, such as treatment, disorder, or test
- look for specific information to make treatment decisions
- sometimes called "PICO" questions
The four parts of an answerable foreground question are PICO:
- Problem (Patient)
Questions might investigate: prevention, cost-effectiveness, quality of life, clinical findings, prognosis, aetiology, or therapy, among others. The question asked determines the types of evidence searched.
- Who is the patient?
- What clinical terms describe the patient?
- What clinical terms describe the problem the patient is experiencing?
- What steps are you considering?
- What options do you have?
- How specific can you be about your plan?
- Are there alternatives to what you are considering?
- Is there comparative research on treatment options?
- What would you do if you did not take the steps you plan to?
- What result or outcome is most important to your patient?
- What result or outcome do you think is realistic?
- What outcomes are reported in the literature for different treatment options?