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Orange Park: PICO

700 Blanding Blvd. Ste. 16 Orange Park, FL 32605

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 - PICO guide from the Centre for Evidence-Based Medicine (CEBM)

PICO Worksheet & Search Strategy- downloadable Word document provided by the University of Southern California

How to Form an Answerable Clinical Question - Cincinnati Children's walks you through an overview of the PICO method 

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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