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Evidence-Based Practice: Finding the Evidence

Developing focused clinical questions

There are two main types of questions that may arise from a patient dilemma:

  • Background questions address general queries about a particular disease, condition, test or treatment and can often be answered sufficiently using medical textbooks or point-of-care tools (e.g. UpToDate).
  • Foreground questions address aspects of care, therapy options or possible outcomes in relation to a specific patient or situation and require a more in-depth literature search to find the answer.

Answering foreground questions involves developing well-formed, focused clinical questions.  

Firstly, ensure you have mapped your review questions using PCC and refined the parameters in a clearly articulated protocol. You can then use your PCC ( participant, concept, context) breakdown to build your search strategy. (Recommended by JBI)

PCC - Term - Keywords - MeSH

The PICO framework is commonly used to translate and structure patient dilemmas into focused questions. Using PICO helps to identify the important concepts for your search strategy and makes searching for evidence easier and more time effective.

It will direct your search to relevant and precise answers.

PICO for clinical questions framework:

Patient, population or problem:  

Patient, population or problem - What are the characteristics of the patient or population (e.g. disease or condition, age, gender)?
Intervention or exposure - What is the main intervention of interest (e.g. drug or other treatment, diagnostic/screening test)?
Comparison  -  What is the alternative being considered (e.g. standard therapy, placebo, no treatment)?
Outcomes  -  What are the relevant outcomes (e.g. reduced risk of mortality, return to function, accurate diagnosis?
Type of question - See below.


Types of foreground questions

There are five different types of foreground questions, each focusing on a different action in response to the clinical problem.
Identifying the type of question will help focus your search to the best study type using clinical queries filters.

  • Therapy/Intervention
  • Diagnosis
  • Prognosis
  • Harm/Etiology
  • Prevention

PICo for qualitative questions (looks at people's experiences, attitudes, beliefs, opinions, perceptions etc.)

Alternative question formulation structures with links for more information:

SPICE (qualitative) Setting, Population, Intervention, Comparison, Evaluation

PECODR (clinical) Patient, Exposure, Comparison, Outcome, Duration, Results

PESICO (rehabilitaton) Patient, Environment, Stakeholders, Intervention, Comparison, Outcome

COPES (social work) Client-Oriented, Practical, Evidence Search
Client and problem / What you might do / Alternate course of action / What you want to accomplish

ECLIPSE (health management, policy) Expectation, Client group, Location, Impact, Professionals, SErvice

PIPOH (guidelines) Population, Interventions, Professionals/Patients, Outcome, Health Care Setting


Study Designs

Each type of question is best answered by different types of research studies.  Knowing which type of question you are asking will help you decide which resources you need to locate.

Question type


Best study design


The effect of an intervention/s on a patient

Randomised Controlled Trial (RCT)


Ability of a test to differentiate between those with or without a condition

Prospective, blind comparison to a gold standard


The effect of potentially harmful agents

Cohort study or Case control study


The likely progression, outcome or survival time for a condition

Cohort study


Reducing chance of a disease by changing risk factors or early diagnosis & treatment




Select Ovid Database:
P: Patient, Population, Problem or disease
    who are the patients, what is the problem
I: Intervention or Issue
    what we do to them, what are they exposed to
C: Comparison intervention or issue
    what do we compare the intervention with
O: Outcome
    what happens, what is the outcome

EBP Tutorials

Please note that tutorials from other institutions will refer to their own resources. 

Check this subject guide or the CAHS library website to locate the same or similar resources.


Tutorials on formulating a clinical question

Formulate a Clinical Question UWA Faculty of Medicine, Dentistry & Health Science

Find the best evidence UWA Faculty of Medicine, Dentistry & Health Science

Formulating Answerable Clinical Questions  CEBM University of Toronto

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