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Physician Assistants: (PA/MPH) PICO

Foreground and Background Questions

Clinical questions are categorized as background or foreground. Once you determine your question type, look at the box to the right to see what type(s) of studies and appropriate resources you should consult to answer your question. 

Background Questions

  • Ask to obtain general knowledge about an illness, condition, or disease. 
  • Ask who, what, when, where, how, or why

Foreground Questions

  • Ask for specific knowledge to inform clinical decisions. 
  • Deal with specific patient or population; more complex than background questions. 

Examples of background and foreground questions (NYU Libraries)

 

 

What is PICO?

According to the Centre for Evidence Based Medicine (CEBM), well-formed clinical questions are essential in practicing EBM. "To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your search to relevant and precise answers." - CEBM, University of Toronto, Asking Focused Questions

The PICO model is a tool that can help you formulate a good clinical question. Sometimes it's referred to as PICO-T, containing an optional 5th factor. 

 P - Patient,  Population, or  Problem  What are the most important characteristics of the patient? How  would you describe a group of patients similar to yours?
 I - Intervention,  Exposure,  Prognostic Factor  What main intervention, prognostic factor, or exposure are you  considering? What do you want to do for the patient (prescribe a  drug,  order a test, etc.)?
 C - Comparison  What is the main alternative to compare with the intervention? 
 O - Outcome  What do you hope to accomplish, measure, improve, or affect?
 T - Time Factor,  Type of Study  (optional)  How would you categorize this question? What would be the best study design to answer this question? 

Clinical Question Types and Study Design

Foreground questions can be further classified into four groups: therapy, diagnosis, prognosis, and etiology/harm. Certain study designs are better suited for answering particular question types. 

Question Type Definition Appropriate Study Type(s)
 Therapy  Questions about the effectiveness of treatment in  order to achieve an outcome (drugs, surgical  intervention, exercise, counseling, etc.)  Randomized Controlled Trial (RCT)
 Diagnosis  Questions about identification of a disorder in a  patient presenting with specific symptoms  RCT > Cohort Study
 Prognosis  Questions about the progression of a disease or  outcome of a patient with a particular condition  Cohort Study > Case Control Studies > Case Series
 Etiology/Harm  Questions about the negative impact from an  intervention or other procedure  Cohort Study > Case Control Studies > Case Series

 

Finding the Evidence - A PICO Tutorial

This video from the CEBM demonstrates how to use PICO to formulate a clinical question.

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