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Orange Park: PICO

PICO

Evidence-based practice uses the PICO model for formulating a searchable question. 

PICO is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population/Problem

How would I describe the problem or a group of patients similar to mine?

I = Intervention

What main intervention, prognostic factor or exposure am I considering?

C = Comparison

Is there an alternative to compare with the intervention?

O = Outcome

What do I hope to accomplish, measure, improve or affect?

PICO Resources

Formulating a Clinical Question - an interactive tutorial from Boston University

Forming Focused Questions - practice writing out PICO components and then forming a focused question about these case studies

PICO Worksheet & Search Strategy 

How to Form an Answerable Clinical Question - this tutorial from Cincinnati Children's walks you through an overview of the PICO method and then offers several case studies for you to determine what is the clinical question, what is the type of clinical question, and that is the best study design to answer this type of question

Seven Steps to the Perfect Pico  a step-by-step guide to formulating an optimal PICO search 

Types of PICO Questions

Fill in the blanks with information from your clinical scenario:

THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?


PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?


DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?


PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?


ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ 

with/without______________?


MEANING
How do _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Types of Questions

Types of Questions

Primary Question Types

  • Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
  • Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
  • Prognosis: how to estimate a patient's likely clinical course over time due to factors other than interventions
  • Harm / Etiology: how to identify causes for disease (including its iatrogenic forms).

Other Question Types

  • Clinical findings: how to properly gather and interpret findings from the history and physical examination.
  • Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
  • Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
  • Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
  • Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.

From: Sackett, DL. Evidence-based medicine: how to practice and teach EBM.

Copied with permission from Duke University Medical Center Library & Archives

Research Design

Hierarchy of Evidence

The type of question will often dictate the best study design to address the question:

Copied with permission from Duke University Medical Center Library and Archives

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