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.
Evidence-based practice uses the PICO model for formulating a searchable question.
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?
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.
|Element of the clinical question||
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?
Is there an alternative treatment to compare?
What is the clincial 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 audiotaped comedy routines||make a difference in the reduction of reported anxiety.|
Fill in the blanks with information from your clinical scenario:
In_______________, what is the effect of ________________on _______________ compared with _________________?
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?
DIAGNOSIS OR DIAGNOSTIC TEST
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 _______________ 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.