Evidence-Based Practice questions can be classified as background or foreground questions.
Source: Taubman Health Sciences Library at the University of Michigan, 2024; OHSU Library Resources for the School of Nursing, 2024
PICO(T) is a mnemonic used to describe the four elements of a strong clinical foreground question:
P = Population, Patient, or Problem Who is the patient or group of patients motivating the research?
I = Intervention What is the intervention, therapy, preventative measure, diagnostic test, exposure, etc. you are considering?
C = Comparison Is there an alternative intervention to compare? This field may be left blank if there is no comparison or gold standard.
O = Outcome What is the clinical outcome of the intervention?
(T = Timeline) What is the time frame for treatment and/or the measurable outcome?
In [population], how does [intervention] compared to [comparison] affect [outcome]?
Source: Taubman Health Sciences Library at the University of Michigan, 2024; OHSU Library Resources for the School of Nursing, 2024
| Question Type | Definition | Example |
|---|---|---|
|
Treatment (intervention) or Therapy |
Addresses which treatment leads to the best outcome |
In African American female adolescents with hepititis B, how does acetaminophen compared to ibuprofen affect liver function? (NAU Cline Library, 2021) |
| Etiology |
Addresses causes or origins of diseases, factors that predispose toward a certain disease or disorder. |
Are female non-smokers with daily exposure to second-hand smoke more likely to develop breast cancer when compared with female non-smokers without daily exposure? (Claude Moore Health Sciences Library, 2021) |
| Diagnosis |
Addresses which test is more accurate and precise in diagnosing a condition |
In middle-aged men with suspected myocardial infarction, are serial 12-lead ECGs compared with one initial 12 lead ECG more accurate in diagnosing an acute myocardial infarction? (NAU Cline Library, 2021) |
| Prognosis or Prediction |
Determines the clinical course over time and likely complications of a condition |
For patients 65 years and older, how does the use of the influenza vaccine influence the risk of developing pneumonia during flu season compared to not receiving the flu vaccine? (NAU Cline Library, 2021) |
| Meaning |
Determines meaning of an experience for a particular individual, group or community |
How do pregnant women newly diagnosed with diabetes perceive reporting their blood sugar levels to their healthcare providers during their pregnancy and six weeks postpartum? (NAU Cline Library, 2021) |
| Prevention |
Determines how to reduce chance of a disease by identifying and modifying risk factors; diagnosing disease by early screening |
In OR nurses doing a five-minute scrub what are the differences in the presence and types of microbes found on natural polished nails and nail beds and artificial nails at the time of surgery? (NAU Cline Library, 2021) |
| Question Type | Patient, Problem, Population | Intervention | Comparison | Outcome |
|---|---|---|---|---|
| Treatment/Therapy | Patient's disease or condition | Therapeutic measure such as a medication, surgical intervention, life style change | Standard of care, another intervention, placebo | Mortality rate, days lost form work, pain level, disability, etc. |
| Etiology | Patient's risk factors, current health disorders or general health condition. | The intervention or exposure of interest, including some indication of the strength of the risk factor and duration of exposure. | may not be applicable | Disease incidence, rates of disease progression, mortality rates |
| Diagnosis | The target disease or condition. | A diagnostic test or procedure | The current standard diagnostic test for the problem. | Measures of the test utility, such as sensitivity, specificity, odds ratio |
| Prognosis | The main prognostic factor or clinical problem in terms of its severity and duration | The exposure of interest is usually time, sometimes expressed as watchful waiting. | Usually not applicable | Survival rates, mortality rates, rates of disease progression |
| Meaning | Population of interest | A medical diagnosis, therapy, medication, life style change, etc. | May not be applicable | Reported experience or perception of the intervention. |
| Prevention | The patient's risk factors and general health condition | A preventative measure such as a medication or life style change | May not be applicable | Disease incidence, rates of disease progression, mortality rates. |
Source: OHSU Library Resources for the School of Nursing, 2024
| Question Type | Template |
|---|---|
| Treatment/Therapy | In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T)? In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)? |
| Etiology |
Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)? Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)? |
| Diagnosis | Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)? In ________ (P) are/is ________(I) compared with ________(C) more accurate in diagnosing ________(O)? |
| Prognosis | Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)? In _______ (P), how does ________ (I) compared to ________ (C) influence _________ (O) over _________ (T)? |
| Meaning | How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)? |
| Prevention | For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)? |
Source: Northern Arizona University Evidence Based Practice Guide, 2023