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.
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.
PICO is a mnemonic used to describe the four elements of a good clinical foreground question:
P = Population/Patient/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?
Element of the clinical question |
Population/Patient/Problem 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? |
Comparison (optional) Is there an alternative treatment to compare? |
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. |
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.