PICO
PICO is a popular framework for formulating clinical questions, especially those relating to therapy (or intervention) effectiveness. It’s used to develop a well-built clinical question to aid in creating a search strategy. It helps identify searchable aspects of a situation in which a patient or population has a certain condition, and the outcome of interest is related to a therapy or intervention.
PICO stands for:
- P – Populations/People/Patient/Problem
- I – Intervention(s)
- C – Comparison (if any)
- O – Outcome
Example:
For this scenario, we can build our PICO question like this:
P- premature infants in the NICU
I- music therapy
C- no comparison (null comparison)
O- reduction of negative physiological responses (or any positive changes)
Using PICO, we can formulate a focused, answerable question:
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PICO Worksheet and Search Strategy for CINAHLThis form is adapted from Purdue University Libraries.
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Well Built Clinical Question (PICO) WorksheetA worksheet for formulating a PICO question from Duke University Medical Center Library.
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PICO Tool for PubMed SearchingA quick way of searching your PICO question in PubMed. Enter the population and intervention, comparison and/or outcome (if appropriate).You can also select the type of publications you are interested in such as RCTs or systematic reviews. May be useful for scoping searches to find key studies and to get an idea of the potential size of the evidence base. Not recommended for fully comprehensive searches for systematic reviews as the searcher has no control over or evidence of the search strategy for reporting purposes.
Brown, D. (2020). A Review of the PubMed PICO Tool: Using Evidence-Based Practice in Health Education. Health Promotion Practice, 21(4), 496–498.
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Asking Clinical QuestionsA flowchart from the Centre for Evidence Based Medicine.
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Evidence Based Prace Question Development & Search ChecklistBy Roy E. Brown, Virginia Commonwealth University. This checklist is distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0
International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/)
Question Types
Image source: Dartmouth Libraries
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 - illness caused by medical examination or treatment)
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: Duke University Medical Center Library & Archives - Evidence-Based Practice: PICO