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Evidence-Based Practice Guide

The importance of asking the "right" question cannot be overemphasized. There are two types of clinical questions: background and foreground.  While recognizing the difference between the two types of questions can be a challenge, understanding these differences is critical as it impacts the search approach, applicable information resources, and the searcher’s time.

—Sources: Guyatt, 2015, Melnyk & Fineout-Overholt, 2005; Straus, 2011.

Background questions ask for general knowledge about a condition, test, or treatment and can be answered with textbooks, clinical guidelines, or review articles. They have two essential components:

  • A question root (who, what, how, why) and a verb
  • A disorder, test, treatment or other aspect of healthcare
Example: What is mindfulness therapy?
This question can be answered in a psychotherapy textbook, review articles, and online synthesized resources, such as UpToDate. Time may be lost if the researcher or clinician does not realize that the question is looking for general knowledge and is searching for published studies instead of textbooks.

—Sources: Guyatt, 2015, Melnyk & Fineout-Overholt, 2005; Straus, 2011.

Background Resources

Textbooks are a good resource for background information. To find electronic books in the Library Catalog, click on "Advanced Search"; then type in search keywords and select the "Electronic Book" item type.

Links to select medical/clinical textbooks, nursing textbooks and practice guidelines:

Foreground questions form the essence of evidence-based practice and encompass diagnosis, treatment/prevention, etiology/harm, prognosis. They can be answered from scientific research/evidence.

Example: In hospital staff, does mindfulness therapy reduce stress?
This question builds on the background knowledge of mindfulness therapy. The answer may be found in a published study that compares mindfulness therapy with either a control or no intervention.

This foreground question is an example of a treatment/therapy question. More foreground question examples can be found on the PICO Clinical Question and Study Design/Publication Type page.

A well-defined and focused question is comprised of parts. Using a standardized format or framework helps organize the parts of the question and identify key concepts. The PICO mnemonic concept – introduced in 1995 by Richardson, et. al. – was developed to help answer health-related foreground questions by breaking down the question into searchable keywords. Over the years, the framework has evolved to include additional components, such as "T" (Timeframe), "TT" (Type of question + Type of study design). In the UT Southwestern PICO(M) framework, "M" refers to methodology or study design. —Sources: Davies, 2011; Richardson, Wilson, Nishikawa, & Hayward, 1995

Patient, Population, or Problem P
  • What is the important patient problem or condition?
  • How would you describe the important characteristics of the patient?
Intervention or Indicator I
  • What do you want to do to help the patient?
  • Do you want to consider a specific treatment, diagnostic test, or exposure?
  • Is there a prognostic factor that might affect the outcome of the condition?
Comparison or Control C
  • What are the choices of intervention, if any?
  • Are you trying to decide between two different therapies or two different tests?
  • Between a therapy or no therapy (placebo)?
  • Between a new therapy and the standard of care?
Outcome O
  • What are you trying to achieve with the intervention?
  • What is the important outcome for the patient?
Methodology M
  • What is the best study design or methodology for the type of question you are asking?

—Sources: Guyatt, 2015, Melnyk & Fineout-Overholt, 2005; Straus, 2011.