Translating Clinical Questions by Physicians Into Searchable Queries: Analytical Survey Study

Aurélie Seguin, Robert Brian Haynes, Sebastian Carballo, Alfonso Iorio, Arnaud Perrier, Thomas Agoritsas, Aurélie Seguin, Robert Brian Haynes, Sebastian Carballo, Alfonso Iorio, Arnaud Perrier, Thomas Agoritsas

Abstract

Background: Staying up to date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases, and tools can help, but clinicians first need to translate their clinical questions into searchable queries. MacPLUS FS (McMaster Premium LiteratUre Service Federated Search) is an online search engine that allows clinicians to explore multiple resources simultaneously and retrieves one single output that includes the following: (1) evidence from summaries (eg, UpToDate and DynaMed), (2) preappraised research (eg, EvidenceAlerts), and (3) non-preappraised research (eg, PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval.

Objective: Our primary objective was to examine how clinicians formulate their queries on a federated search engine, according to the population, intervention, comparison, and outcome (PICO) framework. Our secondary objective was to assess which resources were accessed by clinicians to answer their questions.

Methods: We performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized controlled trial on search retrieval. Recording account log-ins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (eg, "What is porphyria?") and foreground questions (eg, "Does treatment A work better than B?"). We then analyzed the type of resources that clinicians accessed.

Results: There were 695 structured queries, after exclusion of meaningless queries and iterations of similar searches. We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%). This distribution did not significantly differ between postgraduate residents and medical faculty physicians (P=.51). Queries included a median of 3 search terms (IQR 2-4), most often related to the population and intervention or test, rarely related to the outcome, and never related to the comparator. About half of the resources accessed (314/610, 51.5%) were summaries, 24.4% (149/610) were preappraised research, and 24.1% were (147/610) non-preappraised research.

Conclusions: Our results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians' retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice.

Trial registration: ClinicalTrials.gov NCT02038439; https://www.clinicaltrials.gov/ct2/show/NCT02038439.

Keywords: Web-based resources; clinical information science; evidence retrieval; evidence-based medicine; search engines; search taxonomy.

Conflict of interest statement

Conflicts of Interest: TA, AI, and RBH are editors of American College of Physicians (ACP) Journal Club. The McMaster PLUS service was developed and is maintained by the Health Information Research Unit at McMaster University, Hamilton, Canada, which owns the intellectual property.

©Aurélie Seguin, Robert Brian Haynes, Sebastian Carballo, Alfonso Iorio, Arnaud Perrier, Thomas Agoritsas. Originally published in JMIR Medical Education (http://mededu.jmir.org), 20.04.2020.

Figures

Figure 1
Figure 1
The path from a clinical question to a query using the population (P), intervention (I), comparison (C), and outcome (O) (PICO) framework. Examples are shown for (a) a background question, (b) a foreground therapy question, and (c) a foreground prognosis question.
Figure 2
Figure 2
Synopses, systematic reviews, and select studies of evidence-based medicine resources provided in the federated search engine MacPLUS FS (McMaster Premium LiteratUre Service Federated Search); adapted from Agoritsas et al, 2014. ACP: American College of Physicians.

References

    1. Glasziou P, Burls A, Gilbert R. Evidence based medicine and the medical curriculum. BMJ. 2008 Sep 24;337:a1253. doi: 10.1136/bmj.a1253.
    1. Agoritsas T, Vandvik PO, Neumann I, Rochwerg B, Jaeschke R, Hayward R, Guyatt G, McKibbon KA. Finding current best evidence. In: Guyatt G, Renni D, Meade M, Cook D, editors. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd edition. New York, NY: McGraw-Hill Education; 2014. pp. 29–49.
    1. Agoritsas T, Guyatt GH. Evidence-based medicine 20 years on: A view from the inside. Can J Neurol Sci. 2013 Jul;40(4):448–449. doi: 10.1017/s0317167100014499.
    1. Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA. 2008 Oct 15;300(15):1814–1816. doi: 10.1001/jama.300.15.1814.
    1. Agoritsas T, Iserman E, Hobson N, Cohen N, Cohen A, Roshanov PS, Perez M, Cotoi C, Parrish R, Pullenayegum E, Wilczynski NL, Iorio A, Haynes RB. Increasing the quantity and quality of searching for current best evidence to answer clinical questions: Protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials. Implement Sci. 2014 Sep 20;9:125. doi: 10.1186/s13012-014-0125-9.
    1. Moja L, Kwag KH. Point of care information services: A platform for self-directed continuing medical education for front line decision makers. Postgrad Med J. 2015 Feb;91(1072):83–91. doi: 10.1136/postgradmedj-2014-132965.
    1. Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: How will we ever keep up? PLoS Med. 2010 Sep 21;7(9):e1000326. doi: 10.1371/journal.pmed.1000326.
    1. González-González AI, Dawes M, Sánchez-Mateos J, Riesgo-Fuertes R, Escortell-Mayor E, Sanz-Cuesta T, Hernández-Fernández T. Information needs and information-seeking behavior of primary care physicians. Ann Fam Med. 2007;5(4):345–352. doi: 10.1370/afm.681.
    1. Graber MA, Randles BD, Ely JW, Monnahan J. Answering clinical questions in the ED. Am J Emerg Med. 2008 Feb;26(2):144–147. doi: 10.1016/j.ajem.2007.03.031.
    1. Green ML, Ciampi MA, Ellis PJ. Residents' medical information needs in clinic: Are they being met? Am J Med. 2000 Aug 15;109(3):218–223. doi: 10.1016/s0002-9343(00)00458-7.
    1. Guyatt G, Meade M, Agoritsas T, Richardson WS, Jeaschke R. What is the question? In: Guyatt G, Rennie D, Meade M, Cook D, editors. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd edition. New York, NY: McGraw-Hill Education; 2014. pp. 19–28.
    1. Agoritsas T, Merglen A, Courvoisier DS, Combescure C, Garin N, Perrier A, Perneger TV. Sensitivity and predictive value of 15 PubMed search strategies to answer clinical questions rated against full systematic reviews. J Med Internet Res. 2012 Jun 12;14(3):e85. doi: 10.2196/jmir.2021.
    1. 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 Apr;100(2):121–126. doi: 10.3163/1536-5050.100.2.010.
    1. Thiele RH, Poiro NC, Scalzo DC, Nemergut EC. Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: Results of a randomised trial. Postgrad Med J. 2010 Aug;86(1018):459–465. doi: 10.1136/pgmj.2010.098053.
    1. Haase A, Follmann M, Skipka G, Kirchner H. Developing search strategies for clinical practice guidelines in SUMSearch and Google Scholar and assessing their retrieval performance. BMC Med Res Methodol. 2007 Jun 30;7:28. doi: 10.1186/1471-2288-7-28.
    1. Shariff SZ, Bejaimal SA, Sontrop JM, Iansavichus AV, Haynes RB, Weir MA, Garg AX. Retrieving clinical evidence: A comparison of PubMed and Google Scholar for quick clinical searches. J Med Internet Res. 2013 Aug 15;15(8):e164. doi: 10.2196/jmir.2624.
    1. ACCESSSS. Hamilton, ON: Health Information Research Unit, McMaster University; [2020-03-10]. .
    1. Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care: A systematic review. JAMA Intern Med. 2014 May;174(5):710–718. doi: 10.1001/jamainternmed.2014.368.
    1. Ely JW, Osheroff JA, Ebell MH, Bergus GR, Levy BT, Chambliss ML, Evans ER. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999 Aug 07;319(7206):358–361. doi: 10.1136/bmj.319.7206.358.
    1. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA. Obstacles to answering doctors' questions about patient care with evidence: Qualitative study. BMJ. 2002 Mar 23;324(7339):710. doi: 10.1136/bmj.324.7339.710.
    1. Haynes B, Glasziou P, Straus S. Advances in evidence-based information resources for clinical practice. ACP J Club. 2000;132(1):A11–A14.
    1. Slawson DC, Shaughnessy AF. Obtaining useful information from expert based sources. BMJ. 1997 Mar 29;314(7085):947–949. doi: 10.1136/bmj.314.7085.947.
    1. Trevena LJ, Irwig L, Isaacs A, Barratt A. GPs want tailored, user friendly evidence summaries--A cross sectional study in New South Wales. Aust Fam Physician. 2007 Dec;36(12):1065–1069.
    1. Allan GM, Ma V, Aaron S, Vandermeer B, Manca D, Korownyk C. Residents' clinical questions: How are they answered and are the answers helpful? Can Fam Physician. 2012 Jun;58(6):e344–e351.
    1. Kritz M, Gschwandtner M, Stefanov V, Hanbury A, Samwald M. Utilization and perceived problems of online medical resources and search tools among different groups of European physicians. J Med Internet Res. 2013 Jun 26;15(6):e122. doi: 10.2196/jmir.2436.
    1. Fiander M, McGowan J, Grad R, Pluye P, Hannes K, Labrecque M, Roberts NW, Salzwedel DM, Welch V, Tugwell P. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes. Cochrane Database Syst Rev. 2015 Mar 14;(3):CD004749. doi: 10.1002/14651858.CD004749.pub3.
    1. Ramos K, Linscheid R, Schafer S. Real-time information-seeking behavior of residency physicians. Fam Med. 2003 Apr;35(4):257–260.
    1. Clark E, Donovan EF, Schoettker P. From outdated to updated, keeping clinical guidelines valid. Int J Qual Health Care. 2006 Jun;18(3):165–166. doi: 10.1093/intqhc/mzl007.
    1. Davidoff F, Florance V. The informationist: A new health profession? Ann Intern Med. 2000 Jun 20;132(12):996–998. doi: 10.7326/0003-4819-132-12-200006200-00012.
    1. Montori VM, Wilczynski NL, Morgan D, Haynes RB, Hedges Team Optimal search strategies for retrieving systematic reviews from Medline: Analytical survey. BMJ. 2005 Jan 08;330(7482):68. doi: 10.1136/bmj.38336.804167.47.
    1. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007 Jun 15;7:16. doi: 10.1186/1472-6947-7-16.
    1. Pluye P, Grad RM, Johnson-Lafleur J, Granikov V, Shulha M, Marlow B, Ricarte IL. Number needed to benefit from information (NNBI): Proposal from a mixed methods research study with practicing family physicians. Ann Fam Med. 2013;11(6):559–567. doi: 10.1370/afm.1565.

Source: PubMed

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