Evidence Based Practice Toolkit

Foreground vs. Background, PICO

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)

Different types of questions

Fill in the blanks with information from your clinical scenario:

THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?

ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?

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 _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

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 cancer what are the current treatments   in the manage-ment of fever and infection?
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?

Asking the clinical question

Evidence based practice requires clinicians make use of the best research they can find to help them in decision-making.

To find that research efficiently, the clinician must ask a well-designed clinical question with all the elements that will lead to finding relevant research literature.

The first step in doing this is to determine if the question is a background or foreground question.

The type of question helps to determine the resource to access to answer the question.

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/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.