Research Guides: Evidence-Based Practice: Ask

Asking the Question

Understanding the types of questions healthcare professionals ask is crucial for effective evidence-based practice. Think of the question as a roadmap guiding your evidence-based practice journey. Just as different terrains require specific tools and methods for navigation, different types of questions require specific approaches and resources to find the best evidence.

What's this about? Why does this happen?

Background questions are broad and foundational, typically seeking general knowledge about a condition, treatment, or disease process.

Which approach is best? How does X affect Y?

Foreground questions, or clinical questions, are more specific and focused, asking how therapies, diagnostic tests, and other interventions compare in terms of efficacy in specific patients or populations. These questions reflect the choices healthcare professionals and patients encounter when making care decisions.

Purpose	Background Questions	Foreground Questions
Therapy	What are the best practices for wound care management?	In adult patients with type 2 diabetes and chronic foot ulcers, how does negative pressure wound therapy (NPWT) compare to standard moist wound dressing in terms of the rate of wound healing?
Diagnosis	What imaging tests are used for confirming a diagnosis of pneumonia in patients presenting with signs and symptoms?	In children aged 6-10, presenting with symptoms of pneumonia, how does chest X-ray compare to lung ultrasound in accurately diagnosing the condition?
Prognosis	What factors influence the prognosis of patients with heart failure?	In elderly patients with heart failure, how does the presence of comorbid diabetes mellitus compare to the absence of diabetes in predicting long-term survival rates?
Prevention	What are the risk factors for catheter-associated UTIs?	In hospitalized patients at risk of catheter-associated urinary tract infections (CAUTIs), does daily bathing of all patients with chlorhexidine cloths compared to disposable non-antimicrobial cloths reduce the incidence of CAUTIs?
Etiology	How does nicotine exposure affect the nervous system?	Are adult patients who smoke less than 5 cigarettes per day at greater risk for stroke than patients who do not smoke cigarettes?

By distinguishing between the types of questions, healthcare professionals can more efficiently search evidence-based medicine resources and navigate the medical literature.

Source: American Medical Association, Guyatt G, Rennie D, Meade M, Cook D. Users' Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. 3rd ed. McGraw-Hill Education; 2015.

Formulating a good clinical question using the PICO(T)(S) framework involves breaking down your question into specific components. We have used an alternate version of the PICO question to include Time (if relevant) and Study (if a certain type of study design is used) to allow the question to be as comprehensive as possible.

PICO(T)(S) Framework

P	Patient/Population/Problem	Who is the patient, population, or problem being studied? Include any characteristics of the patient that may influence the outcome of an intervention, such as age, gender, ethnicity, and specific conditions or diseases.
I	Intervention	What is the main intervention you are considering? This could be a treatment, diagnostic test, procedure, or exposure.
C	Comparison	What is the alternative to the intervention, or the control group? This could be the current, gold-standard treatment, placebo, different treatment, or no treatment at all.
O	Outcome	Define what you and your patient aim to accomplish, measure, improve, or affect. Outcomes can be specific (e.g., reduction in blood pressure) or general (e.g., improved quality of life). Consider how you want the outcome to be measured and reported.
T	Time, if relevant	Include the timeframe over which the intervention is applied, or the outcome is measured. This is optional but can be important for certain questions. When looking for evidence, consider how long a study should last to obtain a reliable result.
S	Study Design, if applicable	Specify the type of study design that would best answer the question. This could be a randomized controlled trial (RCT), cohort study, case-control study, etc.

We can utilize the PICOTS framework across Therapy, Prevention, Diagnosis, Prognosis, and Etiology—which provides a consistent, structured approach to formulating clinical research questions.

Using the same stroke scenario, the table below outlines a PICOTS question for each type of research question.

Stroke Scenario:

A 65-year-old male patient, Mr. Smith, has been diagnosed with an ischemic stroke. He has a history of hypertension and diabetes, and he recently experienced symptoms of sudden weakness on the right side of his body, difficulty speaking, and facial drooping. Mr. Smith is admitted to the hospital where he begins receiving treatment.

PICOTS / Question Type	Therapy	Diagnosis	Prognosis	Prevention	Etiology
P (Patient/Population/Problem)	Patients with ischemic stroke	Patients presenting symptoms of a stroke	65-year-old male patient with ischemic stroke, history of hypertension and diabetes	65-year-old male recovering from ischemic stroke with hypertension and diabetes	65-year-old male with ischemic stroke
I (Intervention)	Administration of tissue plasminogen activator (tPA)	Magnetic Resonance Imaging (MRI)	Standard treatment for ischemic stroke, including thrombolytic therapy, secondary prevention strategies, or rehabilitation	Antiplatelet therapy (e.g., aspirin) combined with lifestyle modification	Exposure: presence of hypertension and diabetes
C (Comparison)	No tPA (control group)	Non-contrast Computed Tomography (CT) scan	No intervention or alternative treatment approaches	Antiplatelet therapy alone	No hypertension or diabetes
O (Outcome)	Improvement in neurological function (NIH Stroke Scale)	Accuracy in diagnosing ischemic stroke	Functional recovery (e.g., improved mobility, speech, and quality of life)	Prevention of recurrent stroke	Increased likelihood of ischemic stroke occurrence
T (Time)	Within 3 hours of symptom onset	Within 24 hours of symptom onset	3 months to 1-year post-stroke	Post-discharge and ongoing follow-up	Over the patient’s lifetime
S (Study, if applicable)	Randomized controlled trial Cohort study	Blind, prospective study that compares one diagnostic method to a another (gold standard) Diagnostic test accuracy study	Cohort Study Case Control Study	Randomized controlled trial Cohort Study Case Control Study	Randomized controlled trial Cohort Study Case Control Study

PICOTS is the recommended format for framing clinical questions being investigated for evidence-based practice. PICOTS is widely used for framing questions in clinical practice guidelines, systematic reviews, randomized controlled trials, and clinical case presentations. Most often, PICOTS questions are stated following a consistent format.

Use the template below to develop a clear and searchable PICOTS question based on your clinical scenario.

Note: Not all PICOTS elements may apply to every scenario or question type.

PICOTS Template

THERAPY

In _______________ (P), what is or how does the effect of _______________ (I) compared with _______________ (C) affect _______________ (O) within _______________ (T) at _______________ (S)?

PREVENTION

For _______________ (P), does the use of _______________ (I) reduce the future risk of _______________ (O) compared with _______________ (C)?

DIAGNOSIS OR DIAGNOSTIC TEST

Are / Is _______________ (P) more accurate in diagnosing _______________ (O) compared with _______________ (C)?

PROGNOSIS

Does _______________ (I) influence _______________ (O) in patients who have _______________ (P)?

ETIOLOGY

Are _______________ (P) who have _______________ (P) at a _______________ risk for / of _______________ (O) compared with _______________ (C)?

Source: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.