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Edward G. Miner Library

School of Nursing: PICO

A guide to essential Miner resources you will need while taking classes at the School of Nursing at the University of Rochester

What is PICO or PICOTT?

Developing a well-built clinical question is one of the foundational skills required for practicing EBP. These questions need to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for relevant and precise answers. PICO makes this process easier. It is an acronym/mnemonic for the important elements of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.

What is PICO or PICOTT?

PICO or PICOTT:

P = PATIENT, POPULATION, PROBLEM - How would you describe a group of patients similar to yours?  What are the most important characteristics of the patient?

I =  INTERVENTION, EXPOSURE, PROGNOSTIC FACTOR - What main intervention are you considering?  What do you want to do with this patient?

C =  COMPARISON - What is the main alternative being considered, if any?

O =  OUTCOME - Include patient oriented outcomes (morbidity, mortality, quality of life, etc).

 

Type of Question - Identify the question scenario:

  • Therapy / Diagnosis / Etiology / Prognosis

Type of Study - Identify study design to help answer question:

  • Systematic review / RCT / cohort study / case controlled

PICO Template

For an intervention/therapy: 

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)? 

 

 

For etiology: 

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)? 

 

 

Diagnosis or diagnostic test: 

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)? 

 

 

Prevention: 

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)? 

 

 

Prognosis/Predictions:

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)? 

 

 

Meaning:

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)? 

 

 

Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.

PICO Video

Types of Clinical Questions

Depiction of PICO elements for therapy or treatment questions

PICO Elements for Therapy or Treatment Questions

Therapy questions are focused on determining the effect of interventions (i.e. treatments) on patient-important outcomes, such as symptoms, mortality, cost, and so on. Notice that the comparison can be another therapy, a placebo, or no intervention.

 Guyatt, G., Rennie, D., Meade, M., & Cook, D. (Eds.). (2015). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (3rd edition.). McGraw-Hill Medical.

Depiction of PICO elements for Diagnosis Questions

PICO Elements for Diagnosis Questions

Diagnosis questions are focused on establishing the usefulness of a test or assessment tool to correctly identify people who have the condition or disease of interest, and correctly identify people who do not have it.

Guyatt, G., Rennie, D., Meade, M., & Cook, D. (Eds.). (2015). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (3rd edition.). McGraw-Hill Medical.

Depiction of PICO elements for prognosis questions

PICO Elements for Prognosis Questions

Prognosis questions are focused on estimating patients' future clinical condition based on factors other than interventions (i.e. treatments). Notice that the I in PICO has been replaced by an E, for Exposure, to illustrate this.

Guyatt, G., Rennie, D., Meade, M., & Cook, D. (Eds.). (2015). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (3rd edition.). McGraw-Hill Medical.

Depiction of PICO Elements for Etiology or Harm Questions

PICO Elements for Etiology or Harm Questions

Etiology questions focus on the effects of exposure to potentially harmful agents or events on patient-important outcomes. Although harmful agents can include treatments, such as chemotherapy, notice that the I in PICO has been replaced by an E, for Exposure.

Guyatt, G., Rennie, D., Meade, M., & Cook, D. (Eds.). (2015). Users’ guides to the medical literature. : essentials of evidence-based clinical practice (3rd edition.). McGraw-Hill Medical.

Types of Studies

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.