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Literature searching for Health Sciences and Medicine

A guide for medical, dentistry and health sciences students undertaking a literature search.

Develop your question using a framework

Frameworks can be a useful tool to help develop a research question and search strategy, particularly a clinical research question and are sometimes a requirement of assessment. 

Sometimes frameworks are not useful for developing a question or identifying terms to search with.

There are many frameworks available, here are the most common:

PICO question

 

The PICO framework is a format for developing an answerable clinical research question prior to starting your research. The question needs to identify the:

  • patient or population we intend to study,
  • the intervention or treatment we plan to use,
  • the comparison of one intervention to another (if applicable) and the
  • outcome we anticipate.

These make up the four elements of the PICO model: Patient / Problem, Intervention, Comparison and Outcome. 


The example question used below: 

For individuals who stutter, does transcranial direct current stimulation as compared to cognitive behaviour therapy improve speech fluency?  

P

Population OR Patient OR Problem

What are the characteristics of the patient or population?
OR 
What is the condition or disease you are interested in?


individuals who stutter

I

Intervention OR Exposure

What do you want to do with the patient? (e.g. treat, diagnose, observe etc.?)


transcranial direct current stimulation

C

Comparison Or Comparator

What is the alternative to the treatment (e.g. placebo, different drug, surgery)?



cognitive behaviour therapy

O

 

Outcome

What is the relevant outcome (e.g. morbidity, complications)?



speech fluency

 

PICO isn't one size fits all

There is no one "correct" way to construct a PICO question. Your clinical question should include elements specific to each client's unique circumstances and values.

   Activity: Building your question with PICO


 

Research questions for quantitative reviews are often mapped using structures such as PICO. Some qualitative reviews adopt this structure, or use an adapted variation of such a structure:

SPIDER

This tool offers a systematic strategy for searching
for qualitative and mixed-methods research studies. 
For instance, qualitative research ‘Outcomes’ “might be unobservable,
or subjective constructs (e.g., attitudes and views and so forth)”
and therefore ‘Outcomes’ (O) becomes the more suitable ‘Evaluation’ (E)
(Cooke et al, 2012, p. 1437).

Sample size

Phenomenon of Interest

Study Design

Evaluation

Research type

SPICE 

SPICE builds upon PICO  in two ways. First, the population component
is separated into two components: setting and perspective.
Second, “outcomes” is replaced with “evaluation” in order to
encourage a broader evaluation framework and incorporate
concepts such as “outputs” and “impact” together.

(Booth, 2006)

Setting – where?  

Perspective – for whom?  

Intervention – what?  

Comparison – compared with what? 

Evaluation – with what result?

PerSPecTIF

An extended question framework that aims to describe both wider context and immediate setting that is particularly suited to qualitative evidence synthesis and complex intervention reviews. (Booth et al, 2019)

Perspective

Setting

Phenomenon of interest/ Problem

Environment

Comparison (optional)

Time/ Timing

Findings

References:

Booth, A. (2006), "Clear and present questions: formulating questions for evidence based practice", Library Hi Tech, Vol. 24 No. 3, pp. 355-368. https://doi.org/10.1108/07378830610692127

Booth A, Noyes J, Flemming K, et al Formulating questions to explore complex interventions within qualitative evidence synthesis BMJ Global Health 2019;4:e001107.

Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 2012 Oct;22(10):1435-43. doi: 10.1177/1049732312452938. Epub 2012 Jul 24. PMID: 22829486.

Central issues in clinical work, where clinical questions often arise

 
  1. Clinical findings : how to properly gather and interpret findings from the history and physical examination
     
  2. Etiology/risk : how to identify causes or risk factors for disease (including iatrogenic harms).
     
  3. Clinical manifestations of disease : knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
     
  4. Differential diagnosis : when considering the possible causes of our patient's clinical problems, how to select those that are likely, serious, and responsive to treatment.
     
  5. Diagnostic tests : how to select and interpret diagnostic tests, to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, safety, expense, and so on.
     
  6. Prognosis : how to estimate our patient's likely clinical course over time and anticipate likely complications of the disorder.
     
  7. Therapy : how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
     
  8. Prevention : how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
     
  9. Experience and meaning (Qualitative): how to empathize with our patients' situations, appreciate the meaning they find in the experience, and understand how this meaning influences their healing.
     
  10. Improvement : how to keep up to date, improve our clinical and other skills, and run a better, more efficient clinical care system.

From: Strauss, SE. Evidence-based medicine: how to practice and teach EBM.