Step 1: Ask a clinical question
The first step of Evidence Based Practice is to identify a clinical query. Then shape it into a focused and answerable clinical question.
Developing a clinical question can help to highlight key concepts from your clinical information need. These key concepts serve as the basis for searching relevant research evidence to address your clinical question.
There are two main types of clinical questions: background questions and foreground questions. Knowing the type of clinical question you want to address can help when deciding where to search for research evidence.
What is a background question?
Background clinical questions are broad and general questions. They can usually be addressed with information found in textbooks, general clinical resources or by the patient themselves.
For example:
- How long have you had these symptoms?
- How do I set up a saline drip?
Addressing a background question can provide understanding around a clinical information need/problem. This can help you to develop a well-informed foreground question.
What is a foreground question?
Foreground clinical questions are complex and specific questions. To be addressed these questions require the most up-to-date and highest quality research evidence.
For example:
- Does handwashing among healthcare workers reduce hospital-acquired infection?
- In patients with osteoarthritis of the hip, is water therapy more effective than land-based exercise in restoring range-of-motion?
Addressing a foreground question can inform clinical decisions and determine the best course of action for patient care.
Tip
To make it easier to find evidence to address your clinical question, time needs to be spent on structuring and refining your question.
Types of foreground questions
There are different types of foreground questions, each focusing on a different action in response to the clinical problem:
Click on the plus (+) icons below to learn about the various types of foreground questions.
Therapy or Intervention
Definition
Therapy or intervention questions explore potential interventions that could be used to treat or manage a patient's condition. They are used to evaluate medications, surgical procedures, exercise, alternative therapies or lifestyles changes.
If you’re asking, 'What should I do to help my patient?' Then you’re asking a therapy or intervention question.
Example foreground question
What is the effectiveness of a particular intervention in improving outcomes in patients suffering from a particular health condition?
Prevention
Definition
Prevention questions explore ways to reduce the likelihood of particular condition or disease. They are used to reduce the chance of disease by identifying and modifying risk factors.
If you are asking, 'How can I prevent a specific outcome for my patient?' Then you are asking a prevention question.
Similar to treatment questions. When assessing preventive measures, it is particularly important to evaluate potential harms as well as benefits.
Example foreground question
What is the effectiveness of an intervention or exposure in preventing morbidity (onset of disease) and mortality?
Diagnosis
Definition
Diagnosis questions compare the accuracy and safety of diagnostic tests against the standard method. They are used to determine which test will be the most accurate in confirming or excluding a particular condition.
If you are asking, 'How should I determine if my patient has a particular condition?' you are asking a diagnosis question.
Example foreground question
What is the ability of a test or procedure to differentiate between those with and without a condition or disease?
Prognosis (Forecast)
Definition
Prognosis questions explore the likelihood of particular outcomes for patients with particular disorders. They are used to predict the patient's expected development and anticipate any future complications.
If you are asking, 'What will happen to my patient in the future?' you are asking a prognosis question.
Example foreground question
How will the disease progress or what is the likelihood that disease will develop?
Etiology (Causation/Harm)
Definition
Harm/etiology questions explore the causes and likelihood of a health care problem. They are used to find the origin of a patient's condition so that decisions about their care can be made.
If you are asking, 'Why has this happened to my patient?' you are asking a harm or etiology question.
Example foreground question
What is the negative impact of an intervention or exposure on a patient?
Meaning/Observational
Definition
Meaning/observational questions delve into understanding the lived experiences, perceptions, and meanings attributed to health conditions or interventions by patients. They aim to uncover the subjective aspects of illness, treatment, and recovery, focusing on qualitative insights rather than quantifiable outcomes.
If you are asking, 'What are my patients' perceptions?' you are addressing a meaning/observational question.
Example foreground question
What are the patient’s experiences of living with an illness?
Frequency
Definition
Frequency questions are aimed at understanding the prevalence or occurrence of a phenomena within a population or group. They seek to quantify the frequency or distribution of specific conditions or behaviours.
If you are asking, 'How many people experience this illness?' you are asking a frequency question.
Example foreground question
How many individuals in the population have a particular condition?
Using question frameworks to shape foreground questions
Question frameworks such as PICO, can be used to help to structure your foreground question, so that relevant evidence can be searched to address the question.
Question frameworks are tools that help to put together a foreground question. These tools identify the key elements of a foreground question, which can be used to formulate a search strategy to find relevant resources/studies that will help answer the foreground question.
There are various types of question frameworks that can be applied to the different types of foreground questions.
Click on the plus (+) icons below to explore the definition, purpose, and examples for each question framework type.
PICO
Definition and purpose
The PICO framework is useful for questions about the effectiveness of interventions.
PICO stands for:
- Population or Patient or Problem
- Intervention or Indicator
- Comparison or Control
- Outcome
Scenario
Wrist splints are commonly prescribed for people with carpal tunnel syndrome. You want to know what evidence there is for their effectiveness in reducing pain and increasing wrist function.
Research question
What is the effectiveness of wrist splints (I) compared with corticosteroid injections (C) for reducing pain and increasing function (O) in for carpal tunnel syndrome (P)?
Framework and scenario matching
| Element | Definiton | Scenario |
|---|---|---|
| P (patient/population/problem) | Who is the population of interest? OR What is the problem of interest? |
People with carpal tunnel syndrome |
| I (intervention/indicator) | What is the intervention or indicator of interest? | Wrist splits |
| C (comparison/control) | What are you comparing the intervention to? | Corticosteroid injections |
| O (outcome) | What is the outcome of interest? | Improvement of pain and wrist function |
Example research paper
Karjalainen, T. V., Lusa, V., Page, M. J., O'Connor, D., Massy-Westropp, N., & Peters, S. E. (2023). Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, (2).
Variant PICO Frameworks
PICO has variations and extensions to accommodate different question types, including qualitative questions. For example:
- PICOS stands for PICO plus Study design
- PICOT stands for PICO plus Time
- PECO stands for Population/Problem, Exposure, Comparison, Outcome
- PECOS stands for Population/Problem, Exposure, Comparison, Outcome, Study design
- PICo stands for Problem, phenomenon of Interest, Context (used on qualitative questions)
PCC
Definition and purpose
The PCC framework is useful for questions that are broad or reviewing qualitative research.
The PCC framework is recommended by the JBI Scoping Review guidelines (11.2.2 Developing the title and question).
PCC stands for:
- Population or Problem
- Concept
- Context
Scenario
The government is funding a review into measuring the experiences of adults with atrial fibrillation. They're particularly interested in the impact atrial fibrillation has on quality of life. You want to apply for the grant and start planning your methodology.
Research question
What tools are available to measure quality of life (C) in adults with atrial fibrillation (P) in Australia (C)?
Framework and scenario matching
| Element | Definiton | Scenario |
|---|---|---|
| P (population/problem) | Who is the population of interest? OR What is the problem of interest? |
Adults with atrial fibrillation |
| C (concept) | What is the concept of interest? | Quality of life measurement |
| C (context) | What is the context? E.g. Geographic, Setting, etc. | Australia |
Example research paper
Risom, S. S., Nørgaard, M. W., & Streur, M. M. (2022). Quality of life and symptom experience measurement tools in adults with atrial fibrillation: a scoping review protocol. JBI evidence synthesis, 20(5), 1376-1384.
PEO
Definition and purpose
The PEO framework is useful for epidemiological questions about exposure to an event or an illness.
PEO stands for:
- Population and their problems
- Exposure
- Outcomes or themes
Scenario
Recently, there have been increasing cases of laryngeal cancer amongst people who work as stonemasons. The research team seeks to examine the literature to determine whether there is an association between exposure to dust through stonemasonry and developing silicosis.
Research question
Is there an association for people who work as stonemasons (P) between occupational exposure to silica dust (E) and laryngeal cancer (O)?
Framework and scenario matching
| Element | Definiton | Scenario |
|---|---|---|
| P (population and their problem) | Who is the population of interest? AND What is the problem of interest? |
People who work as stonemasons |
| E (exposure) | What is the exposure event or exposure disease? | Silica dust |
| O (outcomes or themes) | What is the result or outcome of interest? OR What themes are of interest? |
Laryngeal cancer or silicosis |
Example research paper
Chen, M., & Tse, L. A. (2012). Laryngeal cancer and silica dust exposure: A systematic review and meta‐analysis. American journal of industrial medicine, 55(8), 669-676.
SPICE
Definition and purpose
The SPICE framework is useful for questions evaluating the results of a service, project, or intervention.
SPICE stands for:
- Setting
- Perspective
- Intervention
- Comparison
- Evaluation
Scenario
You are wanting to design a new program to support the well-being of people living with spinal cord injury, but first, you want to know what other programs have been developed, and how they’ve been received by the program participants.
Research question
From the perspective of community-based (S) people living with spinal cord injury (P), what is the impact of well-being interventions (I) on their own quality of life (E)?
Framework and scenario matching
| Element | Definiton | Scenario |
|---|---|---|
| S (setting) | What is the setting? | Community |
| P (perspective) | Whose perspectives and experiences are of interest and what are they? | People living with a spinal cord injury |
| I (intervention) | What is the intervention of interest? | Well-being |
| C (comparison)* | What are you comparing the intervention to? | No comparison |
| E (evaluation) | What is the result? | Impact of well-being interventions on people with a spinal cord injury |
*Note: There may not always be a comparison element.
Example research paper
Simpson, B., Villeneuve, M., & Clifton, S. (2022). The experience and perspective of people with spinal cord injury about well-being interventions: a systematic review of qualitative studies. Disability and rehabilitation, 44(14), 3349-3363.
SPIDER
Definition and purpose
The SPIDER framework is useful to help frame qualitative questions or those involving mixed methods research.
SPIDER stands for:
- Sample
- Phenomenon of Interest
- Design
- Evaluation
- Research type
Scenario
You're beginning a research degree in which you want to investigate barriers to nurses offering cross-cultural care. You want to know whether any studies were undertaken from the perspectives of nurses before you start your research.
Research question
What are the perspectives (E) of nurses and nursing students (S) of their experiences in delivering transcultural care (PI)?
Framework and scenario matching
| Element | Definiton | Scenario |
|---|---|---|
| S (sample) | Who is the group of interest? | Nurses or nursing students |
| PI (phenomenon of interest) | What is the researcher interested in? (e.g. behaviours, experiences) | Experiences of transcultural care |
| D (design) | What study designs will be included in the review? | Interview, survey, focus groups, questionnaires |
| E (evaluation) | What are the outcomes of the research? (e.g. perspectives) | Themes in nurse perspectives |
| R (research type) | What type of research will be included in the review? | Qualitative, mixed methods |
Example research paper
Shahzad, S., Ali, N., Younas, A., & Tayaben, J. L. (2021). Challenges and approaches to transcultural care: An integrative review of nurses' and nursing students' experiences. Journal of Professional Nursing, 37(6), 1119-1131.