Skip to Main Content
 

Evidence Based Practice: 5 A's

The essential first step in EBP

ASK is the essential first step of EBP. 

Developing an answerable clinical research question can help to:

  1. Determine the essential elements of the question (Patient/Population/Problem, Intervention, Control, Outcome)
  2. Differentiate between background and foreground information needs; Identify gaps in knowledge
  3. Assist to develop synonyms for a comprehensive search
  4. Develop a structured search string 
  5. Determine the domain of the question (therapy/treatment, prevention, diagnosis, prognosis, etiology, meaning)

Background vs. Foreground Questions

Background questions: 

Are there elements of the question which require basic (background) research? Is there a gap in the clinician's/researcher's knowledge about specific elements of the question? 

  • What additional information does the clinician/researcher require to better understand the patient/population or problem? 
  • What additional information does the clinician/researcher require to better understand the intervention proposed? 
  • What additional information does the clinician/researcher require to better understand the control variable proposed? 
  • What additional information does the clinician/researcher require to better understand the desired outcome? 

Background question example: 

Asian-American adult female with type 2 diabetes mellitus requests alternatives to insulin treatment. 

  • What is type 2 diabetes mellitus?
  • Is type 2 diabetes mellitus prevalent in the Asian-American community? 
  • What is the standard of treatment for adult women with type 2 diabetes?
  • What should be known about insulin treatments? 
  • What are the effects of untreated type 2 diabetes mellitus?

Foreground question: 

Foreground questions combine predetermined elements of the clinical problem to acquire specific knowledge. They are more complex and specific than background questions. 

Foreground questions combine the Patient/Population/Problem and the Intervention and the Control treatment and the desired Outcome into a PICO format. 

 

PICO format

PICO Elements Considerations
P Patient/Population/Problem Demographics, Problem type, Diagnosis
I Intervention/Exposure Therapeutic, preventative, diagnostic, time, exposure
C  Control/Comparison Placebo, Standard of care, Preventative measure, Not applicable
Outcome Measure Mortality rate, Measure of test, Rate of disease progression, Resolution

When forming your questions using PICO, consider: 

  • Demographic variables can include: age, gender, ethnicity, socioeconomic status in addition to health issue.
  • Comparison is not always an element within the PICO format. 
  • Outcomes measure a positive impact on the patient/populations' wellbeing and should be measurable. 
  • Using the PICO format to develop a searchable & answerable question will provide the elements needed to obtain the best evidence from rigorous studies with statistically relevant findings. 

Question Domain/Type of Evidence

Question Domain

Patient/Population/

Problem

Intervention Control Outcome Measure Level of Evidence

Therapeutic/

Treatment

Disease or condition Therapeutic measures: Exercise, medication, surgical, life style change Standard of care, additional intervention, placebo, no control Measurable improvement in impairment/disease factors Randomized Control Trial (RCT)
Prevention Risk factors, Medical history Preventative measures Alternative preventative measures or no control Measurable improvement in impairment/disease factors RCT or Prospective study
Diagnosis Specific disease or condition Diagnostic test or procedure Standard of care  Measurable results of test/procedure utility/sensitivity/odds ratio RCT or Cohort Study
Prognosis Duration & sensitivity of main prognostic factor or clinical problem Typically time related Typically not applicable Mortality rates or rates of disease progression Cohort Study and/or Case-Control Series
Etiology Risk factors, health disorders, medical history Strength/dose/duration of intervention or exposure (risk factor) of interest Typically not applicable Mortality rates or rates of disease progression Cohort Study

Source: https://canberra.libguides.com/c.php?g=599346&p=4149722

PICO Format Worksheet

I. Determine Clinical Question Elements

PICO Question Elements Your PICO Elements                                                                  

P: Patient/Population/Problem

The most important element of this component

e.g. Diagnosis/disease/condition, age group, gender

 

I: Intervention/Prognostic factor/Exposure/Treatment

 

C: Comparison (if applicable)

e.g. Placebo, standard protocol, no treatment, alternative options

 

O: Outcome (measurable)

e.g. Reduce mortality/morbidity, improved symptoms, accurate/timely diagnosis

 
Your answerable & searchable clinical question:   

II. Match Question Domain with Study Type

Question Domain

  • Therapeutic/Treatment
  • Prevention
  • Diagnosis
  • Prognosis
  • Etiology/Harm

Type of Study

  • RCT
  • RCT, Cohort Study, Prospective
  • RCT, Prospective
  • Cohort Study, Case Control Series
  • RCT, Cohort Study, Case Control Series
Refer to the Evidence Pyramid: Meta-analyses & Systematic reviews will provide the best answers to clinical questions

III. Search strategy development

PICO Primary PICO Elements/Search terms Synonym(s)       MeSh term     
P      
I      
C      
O