Librarian
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 |
Patient / Problem / |
The patient population. This often includes the problem. For example, adolescents with diabetes. |
I |
Intervention / Cause / Prognosis |
Main intervention, prognostic factor, or exposure |
C |
Comparison (to Intervention) |
A comparison of the Intervention. This can sometimes be a a control (absence of intervention or current standard of care). |
O |
Outcome |
What do I hope to accomplish, measure, improve, or affect? Often this is a reduction of symptoms or disease progression. |
T |
Time (if relevant) |
Timeframe. This is not always needed, but in some cases it is essential. For example, the timeframe before administering anesthesia before a surgery is important. |
PICOt examples by Question Type
Intervention/Therapy
In patients with acute bronchitis, (P) do antibiotics (I) reduce sputum production or cough? (O)
Etiology
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)?
Meaning
How do young patients (P) who have had mastectomies (I) perceive reconstructive surgery (O)?
Types of Clinical Questions
Clinical questions can take many forms. Sometimes you may want to know the best treatment for a patient. Other times you may be investigating how a illness is developed. There are several types or categories of PICO questions to help frame the research.
| Definition | PICOt Template | |
|
Intervention/Therapy |
What is the best treatment? |
In__________________(P), how does ________________(I) compared with _________________(C) ______________ affect_____________ within___________________________(T)?
|
Etiology |
What is the origin of the condition or disease? |
Are _______________(P) who have _______________(I) compared to those without _______________ (C) at ______________ risk for/of ________________(O) over____________________(T) ?
|
Diagnostic |
What is best in diagnosing a disease or condition? |
In _____________________(P) are/is ________________(I) more accurate in diagnosing _______________(O) compared with ____________(C)?
|
|
Prognosis/Prediction |
What is the outlook for the progression of a condition or disease? |
In/for ________________(P), how does _______________(I) compared to ________(C) influence ____________________(O) during/over (T)?
|
Meaning |
How does someone experience a condition or phenomenon? How do they feel about it?
|
How do _______________(P) diagnosed with _______________(I) perceive (O) __________________ during_______________(T)? |
* Adapted from Melnyk, & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare : a guide to best practice (Fifth edition.). Wolters Kluwer.
