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Evidence-Based Practice

Asking Good Questions

The key to finding appropriate evidence is to ask a searchable, answerable question.  The PICO framework is often used as a guide for asking clinical questions.

= patient, problem, population
I  = intervention
C = comparison intervention, control
O = outcome(s)

Have you noticed resources that refer to PICOT instead of PICO?  Some EBP experts add T to the standard PICO framework.  The T usually stands for time and can be helpful in making sure you're thinking of the appropriate time frame for your intervention and/or outcomes.

Types of Questions

Questions can often be classified as either background or foreground.  In addition, questions will often have either a core research slant or be focused on a clinical scenario.  For Evidence-Based Practice, you will often want to focus on asking clinical foreground questions; however, sometimes you may need to ask a clinical background question or two before you are able to formulate a good clinical foreground question.

Background: More general; Helps to fill in the background knowledge of the asker.

Foreground: More complex or specific; In clinical scenarios, may focus in to compare different treatments, tests, or approaches to a condition.

Research: Looks more broadly at how a specific condition functions; Often related to bench or basic science topics.

Clinical: Focused on clinical scenarios, such as a specific patient, population, or situation.

The below table illustrates the different types and levels of questions that you may develop

  Background Foreground
Clinical What are the typical interventions used in children with cystic fibrosis? In children with CF, does chest percussion by an adult or chest percussion via a high frequency chest wall oscillation vest result in more significant reductions of perceived dyspnea?
Research What is the genetic mutation at work in cystic fibrosis? In the Delta F508 CFTR mutation, do mutations coupled to either folding of the first nucleotide-binding domain and/or the interaction with the fourth intracellular loop result in resportation of function of the mutation to wild-type levels?

Once you have formed a good clinical foreground question, you can then classify its focus into the following categories.  Thinking about what type of question you are asking will help you determine what types of articles and studies you will likely be able to find to answer your question.

Therapy: Relates to the effectiveness of a therapy or intervention used to treat a condition or disease.; Can be in comparison to another therapy, a placebo, or no intervention at all.
Diagnosis: Determines if a test will provide an accurate diagnosis; Often in comparison to a "gold standard" test.
Etiology: Investigates if harm is caused by an exposure; Exposures can potentially include therapies.
Prognosis: Focuses on the likely future course of a disease or condition; Intervention is often simply time, but can also be patient-related factors, such as age or gender.

How to Build a PICO Question

For more information on how to form a clinical, foreground question using the PICO framework, check out the below resources:

Video created by Jeffrey Hill.  This video is licensed under a Creative Commons Attribution 4.0 International License.


Video created by Clinical Information Sciences. Video created by Show Me The Evidence.