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Asking the Clinical Question

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 vs. Foreground

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)


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?

PICO Examples


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?
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 prognotic factor, absence of risk factor, etc.


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.

Asking Different Types of Questions

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 ______________?

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.