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SOCW 553: Research Knowledge and Evidence in Clinical Social Work Practice

Overview of evidence-based practice, literature review/systematic review workflows, and citation management for your written EBP assignment.

Creating a Question

An evidence synthesis relies on a well-formulated and specific question.

  • Systematic reviews strive to use effect/affect based questions to assess an intervention's potential through the strength of evidence available
    • Note: you'll notice many poorly crafted systematic review questions out there - so if you plan to add to the literature, make sure you're doing so correctly.
  • Scoping reviews usually use more general and open-ended questions to bring together a broader look at all of the research on a topic - they do not seek to gauge the effectiveness of an intervention. Their questions often seek a greater understanding of a topic, so that an effect/affect based question can be used in a future systematic review. 

For the purpose of this assignment, you'll be striving to assess an intervention - so you'll want to focus on building an effect/affect based question. The following information will help you do that. 

Goldilocks Principle

Remember to ensure that your question is not too broad and not too specific - that it is just right. Sometimes this is very challenging to do and you might need to do a few scoping searching in a database to see how much is available on a topic. For more check out the Teachers of Evidence-Based Health Care Goldilocks webpage.

For this assignment, you will not be able to use a question that only yields a handful of results in a search because you need a certain amount per group. But you also need to consider that this assignment needs to be completed in a short window of time, so your search cannot yield too many results upfront. Consult with Arielle to ensure that you're finding enough to complete your assignment. 

Matryoshka Nesting Doll Questions

Another common error is trying to address too many things in one question. Ensure your question is specific and direct in focus and does not try and address multiple intervention effects or multiple populations. 

Picking a Topic

For your assignment - pick a topic for a question that members of your group are familiar with. This is not the best project to endeavour to research something completely new to all of you - as it can be complex at times, and having some background knowledge in the area will help you in completing this - i.e. with keyword development.

Types of Questions

Clinical Foreground Questions:

Foreground questions are used when trying to inform clinical decisions, such as those formed for systematic reviews. These questions are often looking at specific patients or populations, which is why the PICO(T) framework is used. They are often very specific or complex in comparison to background questions (i.e. questions that are routed more in general knowledge or answering an open ended question about an illness, disease, condition, process, or thing). Additionally, comparative interventions are often used in foreground questions. 

Major Categories of Questions:

Remember - you'll need to identify the type of question for your assignment. 

Question Type Definition
Treatment/Therapy Questions that look at which treatment or therapy would lead to the best outcome for the patient.
Diagnosis or Diagnostic Test Questions that seek to find out which test is more accurate and precise in diagnosing a condition. Typically this is used when a patient is presenting with specific symptoms.
Prognosis or Prediction Questions that determine how a clinical course will be over time and any likely complications that might arise in a condition. Typically this is used when looking at the progression of a disease or the likelihood that a disease will occur.
Etiology/Harm Questions that aim to determine the greatest risk factors or causes of a condition. For example, what negative impacts there may be from an intervention or other exposure.
Meaning Questions used to help give meaning or understand an experience for a specific individual, group, or community.

For further reading:

Khan, K., Kunz, R., Kleijnen, J., & Antes, G. (2011). Systematic reviews to support evidence-based medicine: How to review and apply findings of healthcare research. Taylor & Francis. Read chapter: Step 1 Framing Questions for a Review (pg. 9-22)

PICO Framework

The use of the PICO(T) clinical question framework is heavily routed in evidence-based practice. Additions to the framework use other sections - making for PICO(T)(T). 

This page includes more information about the framework and example worksheets that can be used to help visualize the question. 

P - 

  • Patient
  • Population
  • Problem

What is the best way to briefly describe this patient population or situation?

Should consider age, sex, severity of illness, co-existing illnesses, location (US, Canada), socio-economic status, etc.

E.g. pregnant women over 40 with preeclampsia, adolescent boys 13-15, etc. 

I - 

  • Intervention (therapy, test, access to a service, drug, etc.)

What is the intervention?

Should consider the setting, compliance, dosage/intensity, other care being administered, etc.

E.g. a drug, a questionnaire, a test, a procedure, a service, etc.

C - (OPTIONAL)

  • Comparison (another therapy, placebo, or no intervention)

Is there an alternative intervention to compare to?

E.g. placebo, current standard of care, another therapy, no access to a service, etc. 

O -

  • Outcome

Include specific patient-oriented outcomes that are clear before starting the review.

E.g. morbidity, quality of life, decrease in homelessness, increased happiness, lowered depression, etc.

Note: be intentional about the outcomes you are looking for, as reviews are specifically meant to provide conclusions linked to the clinical question's outcome, instead of finding conclusions based on related or tangential outcomes (e.g. surrogate outcomes).

T - (OPTIONAL)

  • Time for completion

Used to identify the time/duration for your data collection or for assessing your outcome.

I.e. how long before you are to see that the intervention is having a positive impact OR the time in which the intervention will be delivered

T - (OPTIONAL)

  • Type of study

What is the ideal study design to answer this question? What type of study design do you realistically anticipate finding? What type of study design do you feel will relate best to providing conclusions on this question?

E.g. randomized-controlled trial, narratives, etc.

For this assignment, you'll be required to find qualitative AND quantitative studies - so you'll want to leave this open most likely. 

Templates for Questions

Question Type Question Template
Treatment/Therapy

In ____ (P), how does ____ (I) compared to ____ (C) affect ____ (O) within ____ (T)?

In ____ (P), what is the effect of ____ (I) compared to ____ (C) on ____ (O) within ____(T)?
Diagnosis or Diagnostic Test In ____ (P) are/is ____ (I) compared with ____ (C) more accurate in diagnosing ____ (O)?
Prognosis or Prediction In ____ (P), how does ____ (I) compared to ____ (C) influence ____ (O) over ____ (T)?
Etiology/Harm Are ____ (P), who have ____ (I) compared with those without ____ (C) at ____ risk for/of ____ (O) over _____ (T)?
Meaning How do ____ (P) with ____ (I) perceive ____ (O) during ____ (T)?