Mr. M is 62 year old and has been diagnosed with prostate cancer and his PSA is 14. He's being seen by a first year oncology resident. The resident is offering a prostatectomy as treatment option, but the patient has asked about the effectiveness of intensity-modulated radiation therapy (IMRT). How does the resident approach the treatment of his patient?
The first stage of evidence-based decision making is to look systematically at the information available. A practitioner can identify the search question and gap in knowledge by reviewing the clinical scenario/topic. The search question can focus on evidence on treatment, diagnosis, prognosis, prevention, etiology, patient experience, or practitioner self-improvement. The search question should be focused, narrow, specific, consist of at least two core concepts/aspects/facets, and phrased as a question.
PICO is a model used in evidence-based practice to frame and answer a clinical question. It consists of four elements or facets:
1) P - Patient, Problem, or Population; 2) I - Intervention; 3) C - Comparison (if needed); 4) O - Outcome(s)
Using the scenario above:
P : 62 y/o with prostate cancer
I : intensity-modulated radiation therapy (IMRT)
C : prostatectomy
O : effectiveness
Search question: “Is there any evidence that intensity-modulated radiation therapy (IMRT) more effective than prostatectomy in treating prostate cancer?”
A quantitative approach can answer many different types of questions, but all can be formatted by following the PICO Model outlined below:
Concept model is one of the models used in evidence-based practice to frame and answer a non-clinical question. The research scenario/topic can be divided to main/primary concepts. The relationship between the concepts can be illustrated by Venn diagram.
In a tumour board rounds, an oncology fellow presented a case of 48 year old female patient with locally advanced breast cancer who received a high dose of Cisplatin and developed an allergic reaction. The tumour board had two recommendations on management of her patient's allergic reaction. 1) stop treatment with Cisplatin if the reaction appears to be allergic. 2) reintroduced the drug with pre-medications or medication to help relieve symptoms.The fellow is interested to find information on organizational/hospital policy on both recommendations.
Concept 1: chemotherapy
Concept 2: allergic reaction
Concept 3: organizational or hospital policy
Search question: "What is the organizational or hospital policy for the management of allergic reactions and/or hypersensitivity to chemotherapy?"