| GROUP | PRIMARY RESPONSIBILITY | NOTES |
|---|---|---|
| ES/SR Team | ✔ | |
| Librarian | Librarian reviews and/or provides feedback on the research question as part of the fee-based service |
Developing a well-defined ES/SR question takes time – it provides the foundation for a successful systematic review/evidence synthesis by:
You should have a draft research question before you choose the type of systematic review/evidence synthesis that you will conduct, as the type of answers you are looking for will help guide your choice of systematic review/evidence synthesis. Using a standardized format or framework, such as PICO or PCC, improves the scientific rigor of the ES/SR and helps organize the parts of the question and identify key concepts. The tabs in this section organize frequently used frameworks by question type/topic.
Clinical or quantitative research questions seek to discover cause and effect relationships by comparing two or more individuals or groups based on different outcomes related to exposures or interventions.
The PICO mnemonic concept – introduced in 1995 by Richardson, et. al. – was developed to help answer health-related intervention/effectiveness questions by breaking down the question into searchable keywords. Key components include:
| Population, Patient or Problem |
What is the important population, patient problem or condition? How would you describe the important characteristics of the population, patient or problem? |
| Intervention, Indicator, Exposure, Prognostic Factor |
What do you want to do to help the patient? Do you want to consider a specific treatment, diagnostic test, exposure or risk factor? Is there a prognostic factor that might affect the outcome of the condition? |
| Comparison or Control |
What are the choices of intervention, if any? Are you trying to decide between two different therapies or two different tests? Between a therapy or no therapy (placebo)? |
| Outcome |
What are you trying to achieve with the intervention? What is the important outcome for the patient? |
| Methodology |
What is the best study design or methodology for the type of question you are asking? |
What is the effect of Enhanced Recovery After Surgery (ERAS) (I) after primary elective total hip arthroplasty (THA) (P) or total knee arthroplasty (TKA) (P) on hospital length of stay (O), total procedure-related morbidity(O), and readmission (O)?
In breast cancer survivors (P), what is the effect of exercise (I) on quality of life (O)?
In critical care patients (P), is chlorhexidine gluconate bathing (I) more effective than conventional bathing (C) in preventing healthcare-associated infections (O)?
Over the years, the PICO framework has evolved to address other systematic review typers. Table 1 (Munn et al 2018) summarizes key elements for formulating a question for ten different review types. Select examples:
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.
Qualitative research questions seek 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.
PICO variants that have been adapted to work better with qualitative studies. The PICo mnemonic stands for the Population, the Phenomena of Interest and the Context. There is no need for an outcome statement in qualitative synthesis (see JBI Manual for Evidence Synthesis, Chapter 3). The expression of the phenomena of interest represents the outcome, therefore a specific outcome section or statement is not recommended in meta-aggregation.
| Population, Patient or Problem | What are the characteristics of the population or patient? What condition or disease are you interested in? |
| Phenomena of Interest | The phenomena of interest, related to a defined event, activity, experience or process |
| Context | The setting or distinct characteristics |
How do parents (P) handle end-of-life decisions (I) of their children (Co)?
What are the experiences of men (P) with prostate cancer (Co) selecting conservative treatment (I)?
The CLIP mnemonic evolved to ECLIPSE to assist in searching for health policy/management information.
| Expectation | What does the search requester want the information for (the original ‘I’s)? |
| Client Group | At whom is the service aimed? |
| Location | Where is the service sited? |
| Impact | What is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured? |
| Professionals | Who is involved in providing/improving the service? |
| Service | Which service are you looking for information? |
The Joanna Briggs Institute (JBI) approach to conducting and reporting scoping reviews is consistent with the PRISMA-ScR checklist. While other frameworks can be used based on the nature of the review, JBI recommends the use of the PCC framework for scoping reviews.
Like other frameworks, the scoping review question guides and directs the development of the specific inclusion criteria for the scoping review. A well-defined scoping review question assists in developing the protocol, identifies key concepts to use in the literature search, and provides a clear structure for the development of the scoping review. As with the title, the question should incorporate the PCC elements.
Generally, a scoping review will have one primary question. If that question sufficiently addresses the PCC and adequately corresponds with the objective of the review, sub-questions will not be needed. However, some scoping review questions benefit from one or more sub-questions that delve into particular attributes of Context, Population or Concept. Sub-questions can be useful in outlining how the evidence is likely to be mapped.
| Population, Patient or Problem | Important characteristics of participants, including age and other qualifying criteria. |
| Concept | Use the ideas from your primary questions to determine your concept. The core concept examined by the scoping review should be clearly articulated to guide the scope and breadth of the inquiry. This may include details that pertain to elements that would be detailed in a standard systematic review, such as the "interventions" and/or "phenomena of interest" and/or "outcomes". |
| Context | May include cultural factors such as geographic location and/or specific racial or gender-based interests. In some cases, context may also encompass details about the specific setting |
The objective of Russell et al’s scoping review (2021) is to identify and map the evidence on the types of dietary education programs that have been implemented and evaluated in any setting (including hospitals, care facilities, educational institutes, and at home) for adults with neurological diseases. The authors included the review questions and corresponding PCC framework in the protocol:
P = adults (≥ 18 years of age) with a neurological disease
C (concept) = dietary education programs (ie, education strategies to improve food and nutrition-related behaviors) that use behavior change techniques and/or behavior change theories
C (context) = studies that have implemented a dietary education program in any setting, including educational institutions, community centers, hospitals, care facilities, and home settings
JBI Manual for Evidence Synthesis by 
Piecing Together Systematic Reviews and Other Evidence Syntheses (ProQuest Ebook Central) by 