Define question

• The success or failure of your systematic review is heavily influenced by the design of the question.
• There are different types of questions.
• When developing your research question, you need to know whether it is an intervention, etiological, prognostic, diagnostic or screening intervention type question.
• Intervention questions look at the effect of a treatment on different outcomes.
     For example, What is the effect of taking Panadol on headaches?
• Etiological questions look at the causative factors of a disease.
     For example, What is the effect of smoking on lung cancer?
• Prognostic questions explore the likelihood of particular outcomes for patients with particular disorders.
     For example, What is the prognosis for men diagnosed with prostate cancer?
• Diagnostic questions compare the accuracy and safety of diagnostic tests against the standard method. 
     For example, How effective is x-ray compared to MRI in diagnosing muscle or ligament tears?
• Different question types are best answered by different types of evidence (i.e. study types).

• Are you capable of addressing the question with the evidence available?
• Have you done a preliminary search to identify a sensible boundaries for your review?
• Will your review question potentially retrieve unmanagable quantities of information? 
• Is your question answerable with existing evidence?

• Do you find your topic interesting?
  You are going to spend a significant amount of effort and commitment in this review, so it is important that you are interested in the review question.

• Does your question address a meaningful 'gap' in the knowledge?
• Have you checked if there is a same/similar synthesis already published?
• Have you checked if there is an on-going review in PROSPERO register?

• Does your question have any political implications that may potentially broaden the health inequality?
  For example, have you explicitly described the effect of the intervention not only on the greater population, but also on disadvantaged groups or/and health inequality within the community?

• Have you consulted with stakeholders in your field and defined the focus of your question?
• Are the findings of your review relevant enough to facilitate others informing their decisions?

• Consider the following scenario:

A GP with a special interest in smoking cessation wants to encourage his practice to engage with teenagers to stop them smoking. In order to persuade his colleagues, he wants to see what evidence is available, particularly on the effectiveness of brief intervention techniques.

• PICO is a way of formulating your question and identifying potential search terms to retrieve the best set of results possible.
  • P stands for patient, population, or problem.
  • I stands for intervention.
  • C stands for comparison or control.
  • O stands for outcome.
• Authors use different phrases to describe the same concepts, so it is necessary to think of alternative words to include in your search in order to capture all of the relevant literature.
• In the example above, the P element is teenagers. They may also be described as adolescents or young people.
• The I element is 'brief intervention'. This can also be called brief advice, brief counseling, or minimal advice.
• The O element is smoking cessation, but authors may also refer to patients who stop smoking or quit smoking.
• It's not always necessary to use all four arms of the PICO framework. This example does not use a control or comparator. 
• Bringing all the elements together, we get the following focused question:

Can brief intervention be used as an effective smoking cessation technique with teenagers?

• It is important to keep this question in mind at every stage of the search process. It is the key to retrieving a focused set of results for your search.