How to develop a focused research question for a rapid evidence review

Rapid reviews are emerging as an alternative to systematic reviews, and they are now widely used to inform decision-making in healthcare. During COVID-19 pandemic, rapid reviews became more widespread. Some teams prepare reviews in a matter of days, instead of several weeks using streamlined systematic review methods. There are multiple roles for librarians within the evidence review process. As an expert searcher, the librarian must interact with the researchers, clinicians, and decision makers. A well-defined research question needs extreme specificity and preciseness which guides rest of the review. Developing a focused question workshop provided an overview of rapid review methods. Discussion and activities on developing a focused research question. How to start with broad topic and narrow it down to a question that is clear, relevant and answerable.


Introduction
At the centre of the systematic review process is the concept of evidence-based medicine (EBM), which Sackett defines as "the conscientious, explicit and judicious use of current evidence in making decisions about the care of individual patients" (1).Evidence-Based Medicine (EBM) have expanded the role of the librarian beyond identification of the literature to be involved in other stages of the systematic review process.Systematic reviews are considered to be the "gold standard" research design, they attempt to identify, appraise, and synthesise all empirical evidence that meets an explicit eligibility criterion to answer a highly focused research question.However, conducting a systematic review can be time consuming and resource intensive.Healthcare organizations, clinicians, and policy makers require high-quality evidence in a timely manner to support decisions about healthcare policy and interventions.Therefore, rapid reviews are becoming increasingly commissioned and used within health and social care.Since librarians have been conducting systematic reviews for many decades, it is expected of librarians to be involved in the rapid review process.This paper will describe important issues discussed in the workshop on "How to develop a focused research question for a rapid evidence review" held at the EAHIL 2023 conference in Trondheim, Norway and reiterate the importance of developing a well structed question.

Background to rapid review methods
Rapid reviews have emerged as a streamlined approach to synthesizing evidence.There is no formal methodology to perform rapid reviews.There are other challenges including no clear definition for a rapid review, and even the term "rapid" varies amongst the research community.During COVID-19 pandemic, rapid reviews have become more widespread.Number of rapid review teams prepare reviews in a matter of days, instead of in several weeks (2).In recent years there have been a number of publications on numerous rapid review approaches (3).Cochrane Rapid Reviews Methods Group whose scope is to inform rapid reviews in general, both within the Mala K. Mann (5).The purpose of this document is to provide guidance on the process of conducting rapid reviews.The process is outlined, and it is implied that the timeline for preparing reviews may vary from a few days to several weeks due to the scope of the rapid review.The Palliative Care Evidence Review Service (PaCERS) review methods were published in 2019 and describe the stages of the rapid review process.The paper mentions the importance of engaging with the stakeholders throughout the review process, particularly developing and refining the review question.In recent years there has been an attempt to identify a definition for a rapid review.In the EAHIL workshop, we discussed a variety of definitions.A widely used definition for a rapid review is "a rapid review is a type of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a short period of time" (6).Also, "a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting specific methods to produce evidence for stakeholders in a resource-efficient manner" (7).The PaCERS definition which clarifies the streamlined process and the time involved in conducting the review "a review conducted within 8-10 weeks using highly refined research question and search carried out within limited set of databases and other sources and increasing the transparency of our methodology and explicitly summarising it for each review" (8).This definition also refers to a "highly refined research question" which is a key component of a rapid review.

The EAHIL workshop
The overall workshop objective was to give participants experience of developing a focused research question for a rapid review.The first stage in the review process is formulating the research question.The process of translating a general research aim or purpose into a research question can be challenging.The research question must be clear and answerable.It is possible to use a broad topic of interest and importance, then to narrow the topic to focus on a different component to develop the review question (Figure 1).An advantage of a broad question is the ability to assess generalizability of findings across types of participants.An advantage of a narrow scope is the manageability for review team and the ease of reading of the review (9).For a rapid review it is essential to ensure the question is clearly articulated and narrow in its structure.
A poorly structured research question may create problems that affect all subsequent stages and impact on the timeliness of the review (10).A well-defined research question needs specificity and preciseness which facilitates rest of the review process.It determines eligibility criteria; informs the development of the search strategy and the data extraction forms.In addition, the review synthesis depends on the type of review question.

Using frameworks to develop research questions
A good rapid review question should be clear and focused, consider using a research framework.FINER criteria (11) help reviewers to formulate an answerable research question, by highlighting useful concepts.For example, could the research be: • feasible; • interesting; • novel; • ethical; • relevant.When developing questions for policy makers and clinicians, it is crucial to understand the feasibility of the research question.Though the FINER criteria outline the important aspects of the question in general, it is helpful to use a framework to develop the question.There are a vast range of formats that can be utilised when developing research questions.

Research question for a rapid evidence review
The most used format is the PICO/PECO format for clinical and healthcare related questions, frequently used for searching for quantitively designed studies (12, 13) (Table 1).
Whereas for a qualitative question the SPIDER tool adapted from the PICO format and is designed to structure qualitative and mixed-methods research (14) (Table 2).
The SPICE format is useful for social sciences topics, or qualitative research questions that require subjective evaluation (15) (Table 3).
Framing the question helps to identify key concepts, which would provide the focus for developing the search strategy.Question formats are helpful tools researchers can use to structure a question that will facilitate a focused search.However, if it is not feasible to use a conceptual structure, it is important to break your research question into separate parts and identify the main components.

Conclusion
One cannot argue that a search strategy underpins any well-conducted evidence synthesis.However, a clearly defined review question and inclusion criteria provide the foundation for a well-constructed search strategy (16).To develop a robust search strategy, the review question needs to be well defined.Formulating a focused research question for a rapid review can be a lengthy process.While you may have an idea about the topic you want to explore, your specific research question is what will drive your review and requires some consideration.A strong research question will accurately and succinctly demonstrate up the review's line of inquiry.

Fig. 1 .
Fig. 1.From a broad topic to a research question.
Types of studies Types of studies (RCT's, CCT's,Case Control etc.)