Evidence-Based Practice: Clinical Questions & PICO

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.

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.

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 scenario: A 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?