Foreground questions ask for specific knowledge one can apply to a specific patient or problem. They often compare two things: two drugs or treatments, the prognosis of two groups, two diagnostic tests, or the harms or benefits of two approaches. They often require primary sources that synthesize a wide range of knowledge, and are more difficult to answer than background questions. Foreground questions are typically clinical questions that require evidence-based answers. Use the PICOT format (see below) to develop these.
Foreground questions require primary sources, such as scholarly journal articles accessed through databases such as CINAHL and Medline. Scholarly research articles published in peer-reviewed journals provide the evidence in Evidence-Based Nursing Practice.
PICOT is a framework that nurses can use to formulate effective clinical questions in a step-by-step manner. Nurse clinicians are faced with many situations for which they do not have the information needed to provide the best care for their patients. From this uncertainty springs forth clinical inquiry.
Clinical inquiry is a process in which clinicians gather data using narrowly defined clinical parameters. This process allows for the investigation of available choices of treatment, for the purpose of finding the most appropriate choice of action. Clinical inquiry is encased in the form of a clinical question.
PICOT is a useful format and structure for developing a clinical research question. PICOT helps the clinician in finding the information needed to answer questions and decrease uncertainty.
| P - specific patient population of interest | What patient population/problem are you trying to address? |
| I - Intervention or issue of interest | What will you do for the patient or problem? |
| C - comparison with another intervention/issue | Alternatives to your chosen intervention (optional) |
| O - outcome of interest | What will be improved for the patient or problem? |
| T - timeframe (optional) | Time period may be an important variable. |
| P - Patient, Population, or Problem | How would I describe a group of patients similar to mind? |
| I - Intervention, prognostic Factor, or Exposure | Which main intervention, prognostic factor, or exposure am I considering? |
| C - Comparison to Intervention (if approp.) | What is the main alternative to compare with the intervention? |
| O - Outcome you would like to measure or achieve | What can I hope to accomplish, measure, improve, or affect? |
