Responsible Literature Searching Guide

Types of Questions

Developing a well-defined question takes time – it is the first step of a responsible literature search and provides the foundation by:

• Focusing where to look for the information
• Identifying key search topics

Searching is an iterative process; do not be surprised if the question needs to be revised after an initial search of the literature. The effort invested to develop the question, will not only save time but will more likely identify relevant information.

There are two types of questions: background and foreground. While recognizing the difference between the two types of questions can be a challenge, understanding these differences is critical as it impacts the search approach, applicable information resources, and the searcher’s time.

Background Questions

Background questions ask for general knowledge about a condition, test or treatment. This type of question has two parts:

1. The starting point of the question (i.e., what, where, when, why, and how)

2. The disease, condition, test, treatment or other healthcare outcome of interest.

Example: What is mindfulness therapy?
This question can be answered in a psychotherapy textbook, review articles, and online synthesized resources, such as UpToDate. Time may be lost if the researcher or clinician does not realize that the question is looking for general knowledge and is searching for published studies instead of textbooks.

Foreground Questions

Foreground questions can be answered from research/evidence and focus on specific knowledge.

Example: In hospital staff, does mindfulness therapy reduce stress?
This question builds on the background knowledge of mindfulness therapy. The answer may be found in a published study that compares mindfulness therapy with either a control or no intervention.

Foreground questions are typically divided further into two categories:

• Quantitative, which seeks to discover cause and effect relationships by comparing two or more individuals or groups based on different outcomes related to exposures or interventions.

Examples:
In breast cancer survivors, what is the effect of exercise on quality of life?
In critical care patients, is chlorhexidine gluconate bathing more effective than conventional bathing in preventing healthcare-associated infections?

• Qualitative, which seeks to discover, describe, and understand rather than test or evaluate.These questions ask about an individual or population’s experience of certain situations or circumstances.They focus on how or what.

Examples:
How do parents handle end-of-life decisions of their children?
How do medical students perceive support by mentors?

Templates for quantitative and qualitative foreground questions help the subject expert (researcher or clinician) develop an answerable question.

(Guyatt, 2015; Health Sciences Library, 2019; Melnyk, 2005)

Quantitative Questions – PICO

A well-defined and focused question is comprised of parts. Using a standardized format or framework helps organize the parts of the question and identify key concepts. The PICO mnemonic concept – introduced in 1995 by Richardson, et. al. – was developed to help answer health-related quantitative questions by breaking down the question into searchable keywords. Over the years, the framework has evolved to include additional components, such as "T" (Timeframe), "TT" (Type of question + Type of study design). In the UT Southwestern PICO(M) framework, "M" refers to methodology or study design (Davies, 2011; Richardson, Wilson, Nishikawa, & Hayward, 1995).  The short article by Oxford Centre for Evidence-Based Medicine provides an overview on study design/methodology and a comparison of advantages and disadvantages,OCEBM Study Designs, 

Key components include:

The following table summarizes the types of quantitative questions as well as the associated study design(s) to answer the question. The sample question templates can be used as a starting point to frame the PICO question. Based on the research topic/clinical problem, the PICO template may need to be modified and may not include all components. (Cullen, 2018; Health Evidence, 2009; Greenhalgh, 2001; Guyatt, 2015; Melnyk, 2005)

(Health Evidence, 2009; Guyatt, 2015; McGibbon, 1999; Wessel, 2019)

Qualitative Questions – The PS Model

DiCenso, et. al., suggested that most qualitative questions can be divided into two components.

How do/does _______(P) related questions/experience __________(S)?

How do caregiver-spouses of Alzheimer patients (P) experience placing their spouse in a nursing home (S)?

What is/are _______(P) experience __________(S)?

What are patients' (P) experience with music therapy (S)?

(DiCenso, 2005; Health Evidence, 2009)

Biomedical Research and Study Design

This section discusses biomedical research, types of studies and related design.

Biomedical research encompasses the disciplines of biology and medicine and includes studies at the atomic/molecular/cellular levels to organism level to population level. The debate of basic versus applied/clinical/translational biomedical research is beyond the scope of this LibGuide (Flier & Loscalzo, 2017); however, for simplistic purposes, basic biomedical research is fundamental or pure research and generates experimental data upon which applied or clinical research is based. Examples include – but are not limited to – animal, cell, biochemical, genetic, and drug studies, as well as development and improvement of analytical procedures. Applied and clinical biomedical research is based on basic biomedical research and helps find new and better ways to detect, diagnose, treat, and prevent disease. (Fain, 2013; Grimes & Schulz, 2002; Rohrig, du Prel, Wachtlin, & Blettner, 2009)

Clinical biomedical research includes both interventional (or experimental) studies and noninterventional (or observational) studies.

Experimental or Interventional Research

• Involves study of an intervention(s)/exposure(s)/factor (s) that are controlled by the researcher
• May or may not involve randomization of the intervention(s)/exposure(s)/factor(s)
• Includes randomized controlled trial or non-randomized controlled trial

(Bruno, 2016; Fain, 2013; Grimes & Schulz, 2002)

• Dominate the literature
• Lacks randomization
• May or may not have a comparison or control group

Analytical research studies test hypotheses and can be subcategorized as follows:

• Cross-sectional study, which is a snapshot in time. Cross-sectional studies analyze data from a sample at a specific point in time. Prevalence, not incidence, is the focus. Since both outcome and exposure/intervention/factor are determined at the same time, the time-based relation between the two may be unclear. (Example: A cross-sectional study finds obesity to be more common in women with than without arthritis, but it cannot answer whether the extra weight load on joints led to arthritis or did women diagnosed with arthritis become involuntarily inactive and then obese.)
• Cohort study, which looks backward (retrospective) or forward (prospective) in time. Cohort studies proceed in a logical sequence from exposure/intervention/factor to outcome. Retrospective studies study events from the past up until present time (chart reviews). Prospective studies study events from the present until a time in the future. The prospective study design allows researchers to include any exposure or baseline characteristics to be studied. If the exposure/intervention/factor group develops a higher incidence of the outcome versus the group without, then the exposure/intervention/ factor is associated with an increased risk of the outcome. (Example: Compare women taking versus not taking oral contraceptives over time to measure outcomes, i.e., ovarian cancer.) 
• Case-control, which works backward in time. Case-control studies start with an outcome and looks backward in time for exposure/intervention/factor that might have caused the outcome. (Example: Look at the history of women diagnosed with ovarian cancer versus ovarian cancer-free and the use of oral contraceptives.)

Descriptive research studies include the following:

• Case report, which describes the medical history of a single patient
• Case-series report, which describes the medical histories of more than one patient

(Bruno, 2016; Fain, 2013; Greenhalgh, 2019; Grimes & Schulz, 2002)

Application Exercise

The following clinical scenario will be used to illustrate the steps in Responsible Literature Searching.

At a recent follow-up appointment, a breast cancer survivor had questions about resuming her exercise routine and possible effects on her energy levels and well-being. You reassure the patient and tell her that you will forward relevant information on how exercise affects breast cancer survivors’ quality of life.

Here is the PICO(M) of the clinical scenario:

References

Bruno, D. (2016). Study design made easy. Medical Writing, 25(3), 26-30. Retrieved from https://login.foyer.swmed.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=119025569&site=ehost-live&scope=site

Cullen, L., Hanrahan, K., Sigma Theta Tau International, Farrington, M., DeBerg, J., Tucker, S., & Kleiber, C. (2018). Evidence-Based Practice In Action: Comprehensive Strategies, Tools, and Tips From The University of Iowa Hospitals And Clinics. Indianapolis, IN: Sigma Theta Tau International.

Davies, K. S. (2011). Formulating the Evidence Based Practice Question: A Review of the Frameworks. Evidence Based Library & Information Practice, 6(2), 75-80.

DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis: Elsevier Mosby.

Fain, J. A. (2013). Reading, Understanding, and Applying Nursing Research (Fourth Edition ed.). Philadelpha: F.A. Davis Company.

Flier, J. S., & Loscalzo, J. (2017). Categorizing biomedical research: the basics of translation. Faseb j, 31(8), 3210-3215. doi:10.1096/fj.201700303R

Greenhalgh, T. (2001). How to read a paper: the basics of evidence based medicine (Second ed.). London: BMJ.

Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical research: the lay of the land. Lancet, 359(9300), 57-61. doi:10.1016/s0140-6736(02)07283-5

Guyatt, G., Drummond, R., Meade, M.O., Cook, D.J. (2015). Users' guides to the medical literature : a manual for evidence-based clinical practice (3rd ed.). New York: McGraw-Hill Education.

Health Evidence. (2009). Developing an Efficient Search Strategy. Retrieved from https://healthevidence.org/practice-tools.aspx#PT2

Health Sciences Library, M. U. (2019, Sept. 12, 2019). The Researcher's Toolkit: The Research cycle. Retrieved from https://hslmcmaster.libguides.com/research-toolkit/research-cycle

Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: a guide to best practice (Second ed.). Philadelphia: Wolters Kluwer Health.

Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: a key to evidence-based decisions. ACP J Club, 123(3), A12-13.

Rohrig, B., du Prel, J. B., Wachtlin, D., & Blettner, M. (2009). Types of study in medical research: part 3 of a series on evaluation of scientific publications. Dtsch Arztebl Int, 106(15), 262-268. doi:10.3238/arztebl.2009.0262

Wessel, C. B. (2019). Responsible Literature Searching for Research: A Self-Paced Interactive Program. Retrieved from https://cme.hs.pitt.edu/ISER/app/learner/loadModule?moduleId=8381&dev=false