CCH-Asking Searchable, Answerable Questions

Asking Searchable, Answerable Questions Finding the right information amidst an overwhelming amount of information in a timely way is imperative. The first step to accomplish this goal is to formulate the clinical issue into a searchable, answerable question. It is important to distinguish between the two types of questions that clinicians might ask—background questions and foreground questions.

 Background questions are those that need to be answered as a foundation for asking the searchable, answerable foreground question . Background questions are described as those that ask for general information about a clinical issue.

 This type of question usually has two components: the starting place of the question (e.g., what, where, when, why, and how) and the outcome of interest (e.g., the clinical diagnosis). 

An example of a background question is: How does the drug acetaminophen work to affect fever? 

{Acetaminophen is an analgesic and antipyretic drug that has almost no anti inflammatory effects. Its mechanism of action is unknown, but it is thought to act centrally through inhibition of the enzymes cyclooxygenase (COX) type 3 (constitutive) and COX-2b (inducible)}

The answer to this question can be found in a drug pharmacokinetics text. Another example of a background question is: How does hemodynamics differ with positioning? This answer can be found in textbooks, as well. Often, background questions are far broader in scope than foreground questions. Clinicians often want to know the best method to prevent a clinically undesirable outcome. For example, What is the best method to prevent pressure ulcers during hospitalization? This question will lead to a foreground question, but background knowledge is necessary before the foreground question can be asked. In this example, the clinician must know what methods of pressure ulcer prevention are being used. Generally, this information comes from knowledge of what is being used in clinicians’ practices and what viable alternatives are available to improve patient outcomes or it may come from descriptive research, such as survey research. Once the methods most supported are identified, clinicians can formulate the foreground question and ask, between the two most effective methods of pressure ulcer prevention, which one will work best in my population? If a clinician does not realize that the question at hand is a background question, time may be lost in searching for an answer in the wrong haystack (e.g., electronic evidence databases versus a textbook). Foreground questions are those that can be answered from scientific evidence about diagnosing, treating, or assisting patients in understanding their prognosis. These questions focus on specific knowledge. In the first two background question examples, the subsequent foreground questions could be: In children, how does acetaminophen compared to ibuprofen affect fever? and In patients with acute respiratory distress syndrome, how does the prone position compared to the supine position affect hemodynamic readings? The first question builds on the background knowledge of how acetaminophen works but can be answered only by a study that compares the two listed medications. The second question requires the knowledge of how positioning changes hemodynamics (i.e., the background question), but the two types of positioning must be compared in a specific population of patients to answer it. 

The foreground question generated from the third background question example could be: In patients at risk for pressure ulcers, how do pressure mattresses compared to pressure overlays affect the incidence of pressure ulcers? The answer provided by the evidence would indicate whether pressure mattresses or overlays are more effective in preventing pressure ulcers. The most effective method will become the standard of care. Recognizing the difference between the two types of questions is the challenge. 

 a novice may need to ask primarily background questions.

 As one gains experience, the background knowledge grows, and the focus changes to foreground questions.

 Although background questions are essential and must be asked, it is the foreground questions that are the searchable, answerable questions