This document discusses how to formulate clinical questions using the PICOT format. It explains that a well-formulated PICOT question should specify the patient population, intervention, comparison, and expected outcome. It also distinguishes between background questions, which ask for general clinical information, and foreground questions, which can be answered by scientific evidence and often address specific diagnosis or treatment issues. Foreground questions are best answered by rigorous evidence sources rather than textbooks. Formulating clear clinical questions is important as it focuses the information search and allows for better communication and learning.

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Chapter 2: Asking Compelling,
Clinical Questions

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Finding the Right Information at the
Right Time
• The key to successful patient care for any healthcare
professional is to stay informed and as up-to-date as
possible on the latest best practices
• Skills are required to negotiate the information-rich
environment

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Asking Clinical Questions: PICOT Format
• P: Population of interest
• I: Intervention or issue of interest
• C: Comparison of interest
• O: Outcome expected
• T: Time for the intervention to achieve the outcome

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Question
• Tell whether the following statement is true or false.
• A well-formulated PICOT question should specify the
patient outcome that the question will address.

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Answer
• True
• Rationale: A PICOT question should specify the outcome
that is expected from the clinical question.

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The Haystack: Too Much Information
• News of clinical advances often diffuses slowly through
the literature
• Only a small percentage of clinicians access and use the
information in a timely fashion
• The EBP process focuses on incorporating good
information-seeking habits into a daily routine
• Skill at managing electronic resources is essential

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Two Types of Questions
• Background questions
− Ask for general information about a clinical issue
− Specify the staring point and the outcome of interest
• Foreground questions
− Can be answered from scientific evidence about
diagnosing, treating, or assisting patients with
understanding their prognosis
− Focus on specific knowledge

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Question
• Tell whether the following statement is true or false.
• Foreground questions can often be answered by
consulting an up-to-date nursing or science textbook

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Answer
• False
• Rationale: Foreground questions are the frequently
complex and specific clinical questions, which are
answered by consulting rigorous evidence. This evidence
is not typically available in textbooks, which are more
appropriate for answering background questions.

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Clinical Inquiry
• An outcome of uncertainty
• Defined as a process in which clinicians gather data
together using narrowly defined clinical parameters to
appraise the available choices of treatment for the
purpose of finding the most appropriate choice of action

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Types of Foreground Questions
• Intervention questions
• Prognosis/prediction questions
• Diagnosis questions
• Etiology questions
• Meaning questions

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Question
• Which of the following components of a PICOT question
is absent from this clinical question?
“Among patients with dementia, how does use of
reorientation therapy compared to regular, supervised
mobility affect patient agitation?”
a. P
b. I
c. O
d. T

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Answer
• d. T
• Rationale: This question specifies the patient population,
the intervention, the comparison, and the relevant
outcome, but does not provide a time frame.

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Why Work Hard at Formulating a
Question?
• It focuses your search, saving time and energy
• Other benefits of clear questions
− Clearly communicating patient information with
colleagues
− Helps learners more clearly understand content
taught
Practice, Practice, Practice!