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College of Health Professions Evidence Based Practice Portal - 2022 draft revision

Ask

Graphic describing PICOThis page covers the first of the five As -- Asking a research question.  Specifically, it introduces the process of formulating a well-built research question using the PICO method of asking questions in a clinical setting.  PICO stands for:
 
P:  the patient or population about whom the question is being asked, and the health-related challenge she/he/they are experiencing
I: what possible interventions are available to address this challenge
C: what possible comparison treatments are available to be weighed against the interventions identified in I
O: what are the desired outcomes of the intervention or comparison with regard to addressing the challenge
 
The PICO pneumonic was first proposed in 1997 (Sackett et. al.).  Since then, some formulations have added additional letters, resulting in the pneumonic being changed to PICOT, PICOS, PICOTS, or PICOTTS:
 
T: time
T: type of study
S: Setting
 
The University of North Carolina Health Sciences Library notes that PICO(TTS) has both positive uses as well as limitations.  In particular, it is useful for:
  • forming a question that focuses on the most important issue for a patient or a population
  • identifying key terms to use in a search for evidence
  • selecting results that directly relate to the situation
Its limitations include privileging interventions, experimental research, and dominant voices, as further described on this page.

PICO examples: Originally developed by the Oregon Health Sciences University:

  Element
  of the
  clinical
 question 

Patient

Describe as accurately as possible the patient or group of patients of interest

Intervention (or cause, prognosis)

What is the main intervention or therapy you wish to consider?
Including an exposure to disease, a diagnostic test, a prognostic factor, a treatment, a patient perception, a risk factor, etc.

Comparison (optional)

Is there an alternative treatment to compare?
Including no disease, placebo, a different prognotic factor, absence of risk factor, etc.

Outcome

What is the clincial outcome, including a time horizon if relevant?

 Example         In patients with acute
       bronchitis,
       do antibiotics        none        reduce sputum
       production, cough or
       days off.?
 Example         In children with cancer        what are the current treatments         none        in the management of
       fever and infection?
 Example         Among family-members
       of patients undergoing
       diagnostic procedures
       does standard care,        listening to tranquil music,
       or audiotaped comedy
       routines
       make a difference in
       the reduction of
       reported anxiety.      
 Example         In patients with type 2
       diabetes and obesity,
       is bariatric surgery more effective        than standard medical
       therapy
       at increasing the
       probability of
       remission of
       diabetes?

Sackett, D., Richardson, W.S., Rosenberg, W., Haynes, R.B. (1997). Evidence-based medicine: How to practice and teach EBM. Churchill Livingstone.

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