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Evidence Based Practice Toolkit

Looking for background or foreground information?

Background questions ask for general knowledge about a condition or thing.

Foreground questions ask for specific knowledge to inform clinical decisions or actions. 

Background Questions

  • Asks for general knowledge about a disease or disease process
  • Have two essential components:
    • A question root (who, what, when, etc.) with a verb
    • A disorder, test, treatment, or other aspect of healthcare
    • Example: What causes migraines? or How often should women over the age of 40 have a mammogram?

The background question is usually asked because of the need for basic information. It is not normally asked because of a need to make a clinical decision about a specific patient.

Foreground questions

  • Ask for specific knowledge about managing patients with a disease
  • Have 3 or 4 essential components (see PICO below)

PICO(T)

Evidence-based practice uses the PICO(T) model for formulating a searchable question. 

PICO(T) is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population or Problem

How would I describe the problem or a group of patients similar to mine?

I = Intervention

What main intervention, prognostic factor or exposure am I considering?

C = Comparison

Is there an alternative to compare with the intervention?

O = Outcome

What do I hope to accomplish, measure, improve, or affect?

T = Timeframe

The timeframe for data collection or time to outcome. Timeframe is not always included in this model.

PICO examples

 

Element of the clinical question  

Patient

Intervention (or cause, prognosis)

Comparison (optional)

Outcome
Example In patients with acute bronchitis, do antibiotics none reduce sputum production, cough or days off?
Example In children with ADHD do pharmacological stimulants (i.e. Adderall, Foculin)  non-stimulant medications produce reduced instances of impulsivity?
Example Among family-members of patients undergoing diagnostic procedures does standard care, listening to tranquil music, or audiotaped comedy routines make a difference
in the reduction of reported anxiety?
 

Types of Clinical Questions

Fill in the blanks with information from your clinical scenario:

INTERVENTION / THERAPY

In__________________(P), how does  ________________(I) compared with _________________(C) ______________ affect_____________ within______________________________?

 

ETIOLOGY

Are ______________(P) who have _______________(I) compared to those without _______________ (C) at ______________ risk for/of ________________(O) over____________________(T) ?

 

DIAGNOSIS OR DIAGNOSTIC TEST

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

 

PREVENTION

For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

 

PROGNOSIS

Does ____________ influence ______________ in patients who have _____________?

 

MEANING

How do _______________(P) diagnosed with _______________(I) perceive (O) __________________ during_______________(T)?

* Adapted from Melnyk, & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare : a guide to best practice (Fourth edition.). Wolters Kluwer.