Translating a Question Into a Search
Building a search strategy begins with the search vocabulary. Starting with your clinical or research question, the first task is to determine the core terms in your question.
The following example PICO will demonstrate one strategy for setting out core terms:
P: For terminally ill hospice patients,
I: Does palliative care with a spiritual care component,
C: Compared to palliative care without spiritual care,
O: Provide a better quality of life for patients near death?
Finding Core Terms
Step 1: Identify the core terms and phrases embedded in your question.
Step 2: Group them. These are our initial terms.
Q&A:
Q1: Why were the terms "patients," "ill," and "care" (in "palliative care") not included in the list of core terms?
A: The goal of this process is to eliminate non-essential terminology and concentrate on words and phrases that are defining for the represented concepts. In the P of our example, the root word "terminal" in the adjective "terminally" implies the existence of "ill patients." Searching the truncated stem "terminal*" of "terminally" will retrieve every record containing the term, including those with the phrase "terminally ill patients." Searching the full phrase therefore, is unnecessary. So its best to drop redundant words which are implied by the core term.
Q2: Then why circle "hospice," "palliative" and "near death," once the word "terminally" was identified as core? These terms all have similar meanings to "terminal. Why aren't they redundant terms as well?
A: They were circled because they are cognate terms. They are approximate in meaning to "terminal." And this proximity makes them useful for search building. When combined with "terminal" in an OR string, they can help expand search retrieval without sacrificing the concept accuracy of the search.
Q3: Why were no terms from the Comparison line included?
A: The Comparison line is the null hypothesis of the Intervention line. Therefore, no new terms were introduced. So there was nothing to add since the terms were already captured from the Intervention line.
Q4: The term "palliative" appears in the Intervention and Comparison lines of the PICO, not the Patient line. Why is it grouped with the "terminal illness" cluster?
A: The intervention of interest is the "spiritual care" component. "Spiritual care" is present in the intervention but not the comparison. Whereas "palliative care" is the constant of both variables. So the focus of the question is how "spiritual care" affects quality of life for the dying. This is why "palliative care" is not grouped with "spiritual care" in step 2. Hospice, palliative and terminal all have a similarity of reference to patients for whom therapeutic treatment is considered medically futile. Adding "palliative" to the "terminal illness" cluster broadens the list of terms for the patient variable without negatively impacting any of the other variables.