Evidence Based Practice Asking the Clinical Question

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Evidence-Based Practice
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" questions ask for general knowledge about a condition or thing.

"Foreground" questions ask for specific knowledge to inform clinical decisions or actions.

Table of Contents
Overview
Asking the Clinical Question
1. Background questions 2. Foreground questions 3. Pico
Clinical Question Categories
Finding the Evidence: Search Strategies
Levels of Evidence and the Systematic Review
Resources

Background Questions

Ask for general knowledge about a disease or disease process
Have two essential components:
- A question root (who, what, when, etc.) with a verb
- A disorder, test, treatment, or other aspect of healthcare
Example: What causes migraines? or How often should women over the age of 40 have a mammogram?

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.

Answering the background question. A number of textbooks, handbooks and databases may be consulted to effectively answer background questions. The library also has a larger list of ebooks on its Web site.

Foreground questions

Ask for specific knowledge about managing patients with a disease
Have 3 or 4 essential components
- Patient and/or problem
- Intervention
- Comparative intervention (optional, include if relevant)
- Clinical outcome
In young children with acute otitis media, is short-term antibiotic therapy as effective as long term antibiotic therapy?

PICO

PICO is a mnemonic used to describe the four elements of a good clinical foreground question.

P--Patient
I--Intervention
C--Comparison
O--Outcome

Element of the clinical question	Patient 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.	Outcome 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.

Once you have formed your clinical question, it may help you in searching for evidence to understand the category type of your question.

References

Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare : A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.

Strauss, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Evidence-based medicine : How to practice and teach EBM (3rd ed.). Edinburgh ; New York: Elsevier/Churchill Livingstone.

Evidence-Based Practice Asking the Clinical Question

Background Questions

Foreground questions

PICO

Evidence-Based Practice
Asking the Clinical Question