Background questions ask for general knowledge about a condition or thing.
Foreground questions ask for specific knowledge to inform clinical decisions or actions.
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.
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:
How would I describe the problem or a group of patients similar to mine?
What main intervention, prognostic factor or exposure am I considering?
Is there an alternative to compare with the intervention?
What do I hope to accomplish, measure, improve, or affect?
The timeframe for data collection or time to outcome. Timeframe is not always included in this model.
|Element of the clinical question||
Intervention (or cause, prognosis)
|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?
Fill in the blanks with information from your clinical scenario:
In__________________(P), how does ________________(I) compared with _________________(C) ______________ affect_____________ within______________________________?
Are ______________(P) who have _______________(I) compared to those without _______________ (C) at ______________ risk for/of ________________(O) over____________________(T) ?
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
Does ____________ influence ______________ in patients who have _____________?
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.