Nursing

Library resources for the School of Nursing

Background vs. Foreground

Evidence based practice requires that 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 the type of question: background or foreground. The type of question helps to determine the resource to access to answer the question.

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

  • Broad in scope - "The Forest"
  • Provides basics for a a greater grasp of concepts
  • Typically found in textbooks, encyclopedias and reviews
  • Have two essential components: Example: What causes migraines? or How often should women over the age of 40 have a mammogram?
    • A question root (who, what, when, etc.) with a verb
    • A disorder, test, treatment, or other aspect of healthcare

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 to inform clinical decisions or actions.

  • Focused in scope - "The Trees"
  • Requires a grasp of basic concepts to fully comprehend
  • Typically found in journals and conference proceedings
  • Have 3 or 4 essential components (see PICO below)

PICO

PICO 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?

PICO Examples

Element of the clinical question

Patient

 Describe as accurately  as possible the patient or  group of patients of interest.

Intervention (or cause, prognosis)

 What is the main intervention or therapy you wish to consider?
Including an exposure to disease, a diagnostic test, a prognostic factor, a treatment, a patient perception, a risk factor, etc.

Comparison (optional)

  Is there an alternative treatment to compare?
Including no disease, placebo, a different prognostic factor, absence of risk factor, etc.

Outcome

  What is the clinical outcome, including a time horizon if relevant?

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 management of fever and infection?
Example  Among family-members of patients undergoing diagnostic procedures  does standard care,  listening to tranquil music, or audio taped comedy routines  make a difference in the reduction of reported anxiety.

Asking Different Types of Questions

 Fill in the blanks with information from your clinical scenario:

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


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


DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?


PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?


ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________

with/without______________?


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.