Suggestions for structural integrity and standard expression of clinical questions in evidence-based clinical practice guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yicheng ^1,2,3 , XIA Ruyu ^1,2,3 , WANG Yaqi ^1,2,3 , CHAI Qianyun ^1,2,3 , FENG Yuting ^1,2,3 , LIANG Changhao ^1,2,3 ,  FEI Yutong ^1,2,3

1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Beijing GRADE Center, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;

Corresponding?author：

FEI Yutong, Email: yutong_fei@163.com

Keywords：

Clinical question; Question structure and expression; Methodology; Clinical practice guideline

DOI：

10.7507/1672-2531.202209078

Video：

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There are several main obstacles to structure clinical questions in the process of developing evidence-based clinical practice guidelines, such as clinicians have misconceptions about clinical question structure, and clinical questions do not fit clinical practice. These obstacles results in the incomplete structure and not standardized expression of the clinical questions, and reduce the quality and applicability of guidelines. To overcome these obstacles, this article introduced the application and specific details of clinical question framing and expression with practical examples, to assist clinicians in understanding clinical questions and to provide methodological references for clinical question formulation in the guidelines.

Citation： GAO Yicheng, XIA Ruyu, WANG Yaqi, CHAI Qianyun, FENG Yuting, LIANG Changhao, FEI Yutong. Suggestions for structural integrity and standard expression of clinical questions in evidence-based clinical practice guidelines. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 120-124. doi: 10.7507/1672-2531.202209078 Copy

1.	Institute of Medicine. Clinical practice guidelines we can trust. Washington DC:The National Academies Press, 2011: 25-16.
2.	Gallagher Ford L, Melnyk BM. The underappreciated and misunderstood PICOT question: a critical step in the EBP process. Worldviews Evid Based Nurs, 2019, 16(6): 422-423.
3.	Booth A, O'Rourke AJ, Ford NJ. Structuring the pre-search reference interview: a useful technique for handling clinical questions. Bull Med Libr Assoc, 2000, 88(3): 239-246.
4.	Hoogendam A, de Vries Robbé PF, Overbeke AJ. Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. J Med Libr Assoc, 2012, 100(2): 121-126.
5.	Schardt C, Adams MB, Owens T, et al. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak, 2007, 7: 16.
6.	Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc, 2018, 106(4): 420-431.
7.	趙國楨, 馮碩, 張霄瀟, 等. 中醫藥臨床實踐指南: 現狀和思考. 中國循證醫學雜志, 2018, 18(12): 1386-1390.
8.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
9.	Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
10.	楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性, 透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.
11.	朱政, 胡雁, 邢唯杰, 等. 不同類型循證問題的構成. 護士進修雜志, 2017, 32(21): 1991-1994.
12.	Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
13.	Hemingway H, Croft P, Perel P, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ, 2013, 346: e5595.
14.	Yao X, Vella E, Brouwers M. How to conduct a high-quality original study on a prognostic research topic. Surg Oncol, 2018, 27(4): A9-A13.
15.	Chakraborty S, Brijnath B, Dermentzis J, et al. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst, 2020, 18(1): 113.
16.	Zaror C, Deana NF, Espinoza-Espinoza G, et al. Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: a case study. J Eval Clin Pract, 2022, 28(3): 404-410.
17.	Wiercioch W, Nieuwlaat R, Zhang Y, et al. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol, 2022, 143: 91-104.
18.	Kloda LA, Boruff JT, Cavalcante AS. A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: a randomized controlled trial. J Med Libr Assoc, 2020, 108(2): 185-194.
19.	Luijendijk HJ. How to create PICO questions about diagnostic tests. BMJ Evid Based Med, 2021, 26(4): 155-157.
20.	Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club, 1995, 123(3): A12-13.
21.	Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ, 1996, 312(7023): 71-72.
22.	Quinn TJ, Richard E, Teuschl Y, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol, 2021, 28(12): 3883-3920.
23.	Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv, 2018, 2(22): 3317-3359.
24.	Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2018, 2(22): 3292-3316.
25.	Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26.	Neumann I, Izcovich A, Aguilar R, et al. ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Paname?a de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America. Blood Adv, 2021, 5(15): 3032-3046.
27.	Lim W, Le Gal G, Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv, 2018, 2(22): 3226-3256.
28.	Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv, 2018, 2(22): 3257-3291.
29.	朱政, 胡雁, 周英鳳, 等. 推動證據向臨床轉化(三)研究的選題和問題構建. 護士進修雜志, 2020, 35(9): 796-799.
30.	陳薇, 郭宇博, 方賽男, 等. 中醫藥臨床實踐指南中臨床問題的確定. 中國中西醫結合雜志, 2020, 40(2): 220-223.
31.	靳英輝, 韓斐, 王強, 等. 臨床實踐指南制訂方法——指南范圍, 主題及問題的確定. 中國循證心血管醫學雜志, 2018, 10(3): 257-261.
32.	李慧, 陳耀龍, 韋當, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法——臨床問題的構建. 中華中醫藥雜志, 2016, 31(6): 2202-2205.
33.	左紅霞. 臨床護理問題的構建模型/工具. 護理學雜志, 2015, 30(20): 18-22.
34.	Speckman RA, Friedly JL. Asking structured, answerable clinical questions using the population, intervention/comparator, outcome (PICO) framework. PM R, 2019, 11(5): 548-553.
35.	Cheng GY. A study of clinical questions posed by hospital clinicians. J Med Libr Assoc, 2004, 92(4): 445-58.

1. Institute of Medicine. Clinical practice guidelines we can trust. Washington DC:The National Academies Press, 2011: 25-16.
2. Gallagher Ford L, Melnyk BM. The underappreciated and misunderstood PICOT question: a critical step in the EBP process. Worldviews Evid Based Nurs, 2019, 16(6): 422-423.
3. Booth A, O'Rourke AJ, Ford NJ. Structuring the pre-search reference interview: a useful technique for handling clinical questions. Bull Med Libr Assoc, 2000, 88(3): 239-246.
4. Hoogendam A, de Vries Robbé PF, Overbeke AJ. Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. J Med Libr Assoc, 2012, 100(2): 121-126.
5. Schardt C, Adams MB, Owens T, et al. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak, 2007, 7: 16.
6. Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc, 2018, 106(4): 420-431.
7. 趙國楨, 馮碩, 張霄瀟, 等. 中醫藥臨床實踐指南: 現狀和思考. 中國循證醫學雜志, 2018, 18(12): 1386-1390.
8. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
9. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
10. 楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性, 透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.
11. 朱政, 胡雁, 邢唯杰, 等. 不同類型循證問題的構成. 護士進修雜志, 2017, 32(21): 1991-1994.
12. Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
13. Hemingway H, Croft P, Perel P, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ, 2013, 346: e5595.
14. Yao X, Vella E, Brouwers M. How to conduct a high-quality original study on a prognostic research topic. Surg Oncol, 2018, 27(4): A9-A13.
15. Chakraborty S, Brijnath B, Dermentzis J, et al. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst, 2020, 18(1): 113.
16. Zaror C, Deana NF, Espinoza-Espinoza G, et al. Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: a case study. J Eval Clin Pract, 2022, 28(3): 404-410.
17. Wiercioch W, Nieuwlaat R, Zhang Y, et al. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol, 2022, 143: 91-104.
18. Kloda LA, Boruff JT, Cavalcante AS. A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: a randomized controlled trial. J Med Libr Assoc, 2020, 108(2): 185-194.
19. Luijendijk HJ. How to create PICO questions about diagnostic tests. BMJ Evid Based Med, 2021, 26(4): 155-157.
20. Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club, 1995, 123(3): A12-13.
21. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ, 1996, 312(7023): 71-72.
22. Quinn TJ, Richard E, Teuschl Y, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol, 2021, 28(12): 3883-3920.
23. Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv, 2018, 2(22): 3317-3359.
24. Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2018, 2(22): 3292-3316.
25. Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26. Neumann I, Izcovich A, Aguilar R, et al. ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Paname?a de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America. Blood Adv, 2021, 5(15): 3032-3046.
27. Lim W, Le Gal G, Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv, 2018, 2(22): 3226-3256.
28. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv, 2018, 2(22): 3257-3291.
29. 朱政, 胡雁, 周英鳳, 等. 推動證據向臨床轉化(三)研究的選題和問題構建. 護士進修雜志, 2020, 35(9): 796-799.
30. 陳薇, 郭宇博, 方賽男, 等. 中醫藥臨床實踐指南中臨床問題的確定. 中國中西醫結合雜志, 2020, 40(2): 220-223.
31. 靳英輝, 韓斐, 王強, 等. 臨床實踐指南制訂方法——指南范圍, 主題及問題的確定. 中國循證心血管醫學雜志, 2018, 10(3): 257-261.
32. 李慧, 陳耀龍, 韋當, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法——臨床問題的構建. 中華中醫藥雜志, 2016, 31(6): 2202-2205.
33. 左紅霞. 臨床護理問題的構建模型/工具. 護理學雜志, 2015, 30(20): 18-22.
34. Speckman RA, Friedly JL. Asking structured, answerable clinical questions using the population, intervention/comparator, outcome (PICO) framework. PM R, 2019, 11(5): 548-553.
35. Cheng GY. A study of clinical questions posed by hospital clinicians. J Med Libr Assoc, 2004, 92(4): 445-58.

Chinese Journal of Evidence-Based Medicine

Suggestions for structural integrity and standard expression of clinical questions in evidence-based clinical practice guidelines

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