Librarian
Looking for background or foreground information?
Background Questions:
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Asks for general knowledge about a disease or disease process
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Has two essential components: A question root (who, what, when, etc.) with a verb A disorder, test, treatment, or other aspect of healthcare
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Example: What causes migraines? or How often should women over the age of 40 have a mammogram?
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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:
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Ask for specific knowledge about managing patients with a disease
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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:
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P |
Patient/Population/Problem What is the patient group or problem? |
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I |
Intervention (or exposure) What main intervention, prognostic factor or exposure am I considering? |
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C |
Comparison Is there an alternative to compare with the intervention? |
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O |
Outcome What do I hope to accomplish, measure, improve, or affect? |
PICO Categories
There are several categories of PICOs. These categories tend to correspond with research designs. For example, therapy questions are usually answered with experimental designs, such as a randomized control trial.
| Category | Description | Example PICO | Commonly Associated Research Designs |
|---|---|---|---|
| Therapy |
What is the effectiveness of a therapy, treatment, medication, or program? |
In older adults in assisted living (P), is yoga (I) versus no yoga (C), helpful for decreasing stress and anxiety (O)? | Experimental and quasi-experimental designs: RCTs. open label control trial. |
| Diagnosis | What is the best diagnostic tool for a given issue and population? | For people exposed to COVID 19 but not experiencing symptoms (P), is the at home test 3EO Health COVID-19 (I) or the BinaxNOW COVID-19 Antigen Self Test (C) more accurate for diagnosing COVID 19 (O)? | Cross sectional, case control and retrospective study designs. |
| Prognosis | What is likely to happen for patients with a given disease and condition and what might mitigate progression or symptoms? | For women under 30 who have had breast cancer (P), and undergo a mastectomy (I), what is the likelihood of developing cancer again (O)? | Longitudinal, cohort, prospective studies |
| Harm | What is the cause of a symptom or illness? | Are young people (P) with a low fiber diet (I) compared with those with recommended fiber intake (C) at a higher risk for hypertension (O) before age 40? | Longitudinal and retrospective studies |
Adapted from LoBiondo-Wood, G. & Haber, J. (2022). Nursing research: Methods and critical appraisal for evidence-based practice (10th ed.). Elsevier. pgs. 368-369.
