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PICO Questions

Background and Foreground Questions

What are Background Questions?

Background questions are informational questions that improve the understanding of a topic. The questions usually have one or two concepts and do not require the process used in formulating a research or evidence based decision-making questiions. The answers to background questions can be found in books, reference materials and review articles that provide an overview of a topic.

Background questions usually start with what, when, where, how and why in relation to a disorder or aspect of a disorder. (Strauss, SE. et. al. Evidence-based Medicine: How to Practice and Teach EBM. New York: Elsevier, Churchill Livingstone, 2005.)

Examples of basic informational questions:

  • What is Myasthenia Gravis?
  • What are the symptoms of bacteremia?
  • How can we prevent falls  in the elderly?
  • What cooling methods are used to treat heatstroke?

Answers to these questions can be found in secondary sources (informational articles) and tertiary sources (books). A minimum amount of time (5-10 minutes) is all that is needed to locate an authoritative source and find the answers to these questions.

What are Foreground Questions?

Foreground questions are more complex than background questions, and usually contain several concepts. When asking a foreground question, the person asking the question is usually seeking a scientific basis as an answer or evidence based information for clinical decision making.

Foreground questions include a broad range of topics including biologic, psychologic and sociologic issues.(Strauss, SE. et. al. Evidence-based Medicine: How to Practice and Teach EBM. New York: Elsevier, Churchill Livingstone, 2005.) Questions arise from 6 aspects of clinical work: Clinical evidence, diagnosis, prognosis, therapy, prevention and education. (Richardson, WS. The Well-built clinical question: a key to evidence-based decisions. ACP Journal Club. 1995, 123(3): A12-3.)

Examples of foreground questions which might require current scientific studies to answer:

  • What are the causes of surgical wound infection following hip replacement?
  • What factors influence  parents' decisions regarding the refusal to immunize their children?
  • Does the use of cell phones increase the incidence of brain cancer?


PICO Questions

What are PICO Questions?

PICO questions are a type of foreground question, but far more complex. PICO questions usually have 4 components or concepts and are used for clinical decision making. These questions compare the interventions, or actions, of health care professionals when caring for patients for the purpose of deciding which intervention is most beneficial. Most PICO questions address therapy and diagnosis.

Examples of PICO questions:

  • In ventilated patients (P), head-of-bed elevation of 45 degrees (I) compared to 20 degrees (C) reduce incidence of ventilated associated pnemonia (O)
  • In hospitalized children,(P) does the Wong-Baker Pain FACES Rating Scale (I) compared to the Child Medical Fear Scale (C) more effectively evaluate the child's level of pain (O)?
  • In non-ambulatory patients, (P) does turning the patient (I) compared to pressure mattresses (C) reduce the risk of pressure ulcers? (O)

Notice the order of the question and the components, or concepts, in the complex questions.

Video Tutorials



Video on Background and Foreground Information:

For more information, watch this video: Search for Evidence Based Information, by Lynne Fox at the University of Colorado Health Sciences Library, which will go into more detail about background and foreground questions.


Video from WHO on formulating the PICO Question:

This video Formulating Questions and Choosing Patient Important Outcomes from the World Health Organization and McMaster University, is part of the series The Grade Approach--Online Learning Modules for Guideline Development at WHO. The video will advance on it's own, but you may want to watch specific sections again by clicking on the table of contents on the left.