Image source: Pixaby CC0 Public Domain
Search Strategy Checklist
1. Define the topic: know what you are looking for.
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Take the time to write down your topic and consider it from all angles.
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Try to be specific about what it is you want to discover about your topic.
2. Begin to build the question: determine if it is a background or foreground question.
Background Question
Often a literature search seeks to answer a background question (looking for overview or summary information about a disease, a problem, or a population). Textbooks are a great resource for background questions.
Example: Is there recent evidence to support the effective use of therapeutic touch in the elderly?
Foreground Question
Foreground questions seek evidence to answer a need for clinical information related to a specific patient, an intervention or therapy. Scholarly databases and search engines are resources for foreground questions.
Example: Does hand washing among healthcare workers reduce hospital acquired infection?
Identifying the elements of your questions helps to focus your question: In healthcare, it helps to write your question in a PICO format. This format helps you identify concepts and keywords, which ultimately defines and directs your search.
3. Break the question down into its individual concepts.
- Are you looking at a disease/condition?
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Do you want to know diagnosis / therapy / outcome / prognosis / risk factors, etc?
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Is there a particular age group / ethnic group / gender?
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Do you want to know adverse effects / prevention & control / mortality / etiology?
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Ex: pregnant / women / screening / streptococcal infections.
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4. Decide on the words/phrases to describe the concepts.
- Consider all possible words or phrases that might be used to describe the concepts of your topic.
- Include synonyms
- Variations in spelling (US vs. UK)
- Word endings (singular, plural)
- Variant terminology (electrocardiograms, electrocardiography)
- Related terms (cataract extraction, intraocular lens implantation).
- Ex: pregnant/pregnancy – screening/testing – women/woman/female.
5. Search for each concept as a separate set and use subject headings.
- Creating separate sets for each part of your topic allows you to combine and recombine results to modify your strategy as your search.
- Use subject headings (called Medical Subject Headings or MeSH in Medline) to capture concepts rather than specific keywords.
- For example, the MeSH heading “neoplasm” in Medline returns articles that include the keywords neoplasm(s), tumor(s), and cancer(s).
6. Combine your sets.
- Define the relationship between individual sets.
- Use the Boolean operators AND & OR
- AND two sets together returns citations that contain both set concepts.
- OR two sets returns citations that contain either one or both set concepts.
7. Display your results.
- Take a look at your search results.
- Are any of the articles right on target?
- Did you get too many? Too few?
- Nowhere near your topic at all?
- Try checking the subject headings in the “closest fit” article.
8. Refine your search, if necessary.
- Try steps 1-5 over again. You may need to either broaden your search concepts or narrow them.
- Example: staphylococcus aureus becomes staphylococcus infections (and vice versa).
PICO or PICO(TT) Stands For:
Patient or Population or Problem
- Who or what is the question about?
- How would you describe a group of patients similar to yours?
- What are the most important characteristics of the patient/population/problem?
- This may include the primary problem, disease, or co-existing conditions.
- Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.
Intervention, Exposure or Prognostic Factor
- What main intervention/treatment are you considering?
- What do you want to do with this patient?
- Prescribe a drug?
- Order a test?
- Consider surgery?
- What factor may influence the prognosis of the patient?
- Age? Co-existing problems? Genetic conditions?
- What was the patient exposed to?
Comparison(s)
- What is the main alternative intervention/treatment to the above being considered, if any?
- Are you trying to decide between two drugs, a drug and no medication or placebo, surgical techniques, or two diagnostic tests?
- Your clinical question does not have to always have a specific comparison.
Outcome(s)
- What are you trying to accomplish, measure, improve or affect?
- What are you trying to do for the patient?
- Relieve or eliminate the symptoms?
- Reduce the number of adverse events?
- Improve function or test scores?
There are additional elements that round out the well-built clinical question. These help in focusing the question and determining the most appropriate type of clinical evidence:
Type of Question:
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Diagnosis : How to select and interpret diagnostic tests
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Therapy : How to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them
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Prognosis : How to estimate the patient’s likely clinical course over time and anticipate likely complications of disease
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Etiology : How to identify causes for disease, including genetics
Type of Study: What Study Design Would Provide the Best Answer?
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Randomized Controlled Clinical Trials
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Meta-Analysis
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Cohort Studies
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Case Series
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Case Control
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Cross Sectional
Time is another consideration...
The time it takes for the intervention to achieve an outcome or how long participants are observed
Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.
Image source: https://www.researchgate.net/figure/51712915_fig1_Figure-1-EBP-reference-model-step-1-clinical-PICO-question