|
Begin by identifying an important
issue that arises in caring for a patient. Formulate a focused question that
identifies the patient or population, the intervention or exposure, the
comparison when relevant, and the outcome of interest.
| Build a question with PICO |
PICO is especially
useful for questions about interventions. Its four components help make a
question specific and searchable:
| P |
Patient, Population, or
Problem — Who is the question about? Consider clinically relevant
characteristics such as age, condition, and risk factors. |
| I |
Intervention or
Exposure — What treatment, test, preventive measure, or exposure are
you interested in? |
| C |
Comparison or Control
— What alternative, usual care, or absence of exposure is relevant? A
comparison is not necessary for every question. |
| O |
Outcome — What
measurable effect, result, or patient-important outcome do you want to
investigate? |
PICOTT extends PICO by
adding two considerations: T for the type
of clinical question (such as therapy, diagnosis, prognosis, harm, prevention,
or quality improvement) and T for the study
type or methodology that may best answer it. These additions can help guide
your search; they do not prescribe a single study design for every
question.
| Choose a framework that fits the question |
PICO is particularly
useful for intervention questions. Other frameworks may be more appropriate for
different research questions. For example, PEO (Population, Exposure,
Outcome) can structure questions about exposures and associations, while
PICo (Population, Phenomenon of Interest, Context) can support
qualitative research about experiences and perspectives.
| Match the clinical question to the study design |
The designs below are
useful starting points, not fixed rankings. Choose studies based on the precise
question, the available evidence, and the methodological quality of the
research.
| Type of Question |
Study
Designs to Consider |
Therapy / Treatment
Does an intervention improve
outcomes? |
Randomized controlled trials and systematic reviews of relevant
trials. Observational studies may help when trials are unavailable or
impractical. |
Diagnosis
How accurately does a test identify a
condition? |
Diagnostic accuracy studies comparing an index test with an
appropriate reference standard; systematic reviews of diagnostic accuracy
studies. Randomized trials may evaluate whether a diagnostic strategy improves
patient outcomes. |
Prognosis
What is the likely clinical course over
time? |
Longitudinal cohort studies and systematic reviews of prognosis
studies. |
Harm / Etiology
What factors are associated with disease or
adverse effects? |
Cohort and case-control studies; randomized trials when appropriate
and ethical. Case reports and pharmacovigilance data may identify rare or
unexpected adverse effects. |
Prevention
Does an intervention reduce the risk of a
condition or event? |
Randomized controlled trials, cohort studies, and systematic reviews
of relevant studies. |
Quality Improvement
Does a change improve a process or
outcome of care? |
Interrupted time-series studies, controlled before-and-after studies,
randomized or cluster-randomized trials, and mixed-methods evaluations,
depending on the improvement question. |
| Practice: Turn a clinical concern into a PICO
question |
Example 1 —
Therapy
In adults with hypertension, does home blood pressure
monitoring, compared with office-based monitoring alone, improve blood pressure
control?
P: Adults with
hypertension
I: Home blood pressure monitoring
C:
Office-based monitoring alone
O: Improved blood pressure
control
Example 2 —
Prevention
In adults aged 65 years and older, does participation in a
structured balance and strength training program, compared with usual activity,
reduce the incidence of falls?
P: Adults aged
65 years and older
I: Structured balance and strength
training
C: Usual activity
O: Reduced incidence of
falls
Next step: Once
you have a focused question, visit Acquire to
identify appropriate evidence and information resources. |
