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Evidence-Based Practice: Clinical Questions & PICO

Types of Questions

Before beginning your search of the literature, it's important to understand the difference between background and foreground questions. This will guide you to the correct resource to aid you in answering your question.

Background question: Seek to answer foundational knowledge about a condition, illness, disease, etc.

Foreground question: Seek to answer specific knowledge regarding a clinical decision, usually concerning a specific patient, population, or intervention. According to Guyatt et al. there are 5 types of foreground questions: therapy, harm, differential diagnosis, diagnosis, and prognosis.

  1. Therapy: determining the effect of interventions on patient-important outcomes (symptoms, function, morbidity, mortality, and costs)
  2. Harm: ascertaining the effects of potentially harmful agents (including therapies from the first type of question) on patient-important outcomes
  3. Differential diagnosis: in patients with a particular clinical presentation, establishing the frequency of the underlying disorders
  4. Diagnosis: establishing the power of a test to differentiate between those with and without a target condition or disease
  5. Prognosis: estimating a patient's future course

Guyatt, G, Rennie, D, Meade, MO, Cook, DJ. Users' Guide to the Medical Literature: Essentials of Evidence-based Clinical Practice. 3rd ed. New York, NY: McGraw Hill Education, 2015.

Framing the Clinical Question using PICO

Before you can search the literature, it's important that you carefully break down your question into key search terms. Using PICO will guide you in thinking about your question.

Framing the Clinical Question Using PICO

  P=Patient, Population, or Problem I=Intervention(s) or Exposure(s) C=Comparison O=Outcomes

Tips for


Who is your patient? What is the problem? What are the management strategies we are interested in comparing or the potentially harmful exposures about which we are concerned? Diagnostic tests, foods, drugs, surgical procedures, time, or risk factors.  What do you wish to compare to your intervention? For issues of therapy, prevention, or harm, there will always be both an experimental intervention or putative harmful exposure and a control, alternative, or comparison intervention. What are the patient-relevant consequences of the exposure in which we are interested? We may also be interested in the consequences to society, including cost or resource use. It may also be important to specify the period of interest.

Guyatt, G, Rennie, D, Meade, MO, Cook, DJ. Users" Guide to the Medical Literature: Essentials of Evidence-based Clinical Practice. 3rd ed. New York, NY: McGraw Hill Education, 2015.

Example scenarioA 37-year-old female with Bipolar I Disorder is currently taking olanzapine with a mood stabilizer to manage manic or mixed episodes. The patient is experiencing suboptimal effects from the olanzapine including weight gain and poor satisfaction with the medication. Is it safe and effective to switch from olanzapine to ziprasidone in this patient?

P=Patient/Population/Problem I=Intervention or Exposure C=Comparison O=Outcome

37-year-old female, Bipolar 1 Disorder



less weight gain


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