Before you start your search, it is important to have a well-built question. One way to construct a well-built question is to use the PICO model.
PICO stands for patient/population, intervention, comparison and outcomes.
|
Patient/Population |
Intervention |
Comparison |
Outcomes |
|
Who is your patient? |
What do you plan on doing for the patient? |
What alternative are you considering? |
What do wish to accomplish? |
|
Age, sex, race or patient Primary problem Health status |
Diagnostic test Medication Procedure |
Another test, medication or procedure Watchful waiting |
Accurate diagnosis Relieve or improve symptoms Maintain function |
|
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? |
What main intervention, exposure, or prognostic factor are you considering? What do you want to do with this patient? |
What is the main alternative being considered, if any? |
What are you trying to accomplish, measure, improve or affect? |
The PICO framework can be used to break down various types of questions into their component parts:
|
Question Type |
P |
I |
C |
O |
|
Therapy |
Patient characteristics, disease |
Specific drug or procedural intervention |
Comparison intervention (e.g., placebo or no treatment) |
Outcomes of interest (e.g., management of diseases or condition) |
|
Etiology |
Patient or population |
Exposure to certain conditions or risk behaviours |
Absence of certain conditions or risk behaviours |
Outcomes of interest (e.g., development of disease or condition) |
|
Diagnosis |
Patient or problem |
Specific diagnostic tool or procedure |
Alternative diagnostic tool or procedure (e.g., current gold standard) |
Specificity, sensitivity (usually left blank in a search) |
|
Prognosis |
Patient, population, or problem |
Prognostic factor |
None |
Outcomes of interest (e.g., morality. recurrence) |
|
Question Type |
Patient or Problem |
Intervention or Exposure |
Outcome |
Comparison |
|
Therapy |
In patients with hypertension and at least one additional cardiovascular disease risk factor |
Does tight systolic blood pressure control |
Lead to lower rates of myocardial infarction, stroke, heart failure, and cardiovascular mortality |
Compared to conservative control? |
|
Diagnosis |
Among asymptomatic adults at low risk of colon cancer |
Is fecal immunochemical testing (FIT) |
As sensitive and specific for diagnosing colon cancer |
As colonoscopy? |
|
Prognosis |
Among adults with pneumonia |
Do those with chronic kidney disease (CKD) |
Have a higher mortality rate |
Than those without CKD? |
|
Etiology or Harm |
Are women |
With a history of pelvic inflammatory disease (PID) |
At higher risk for gynecological cancers |
Than women with no history of PID? |
|
Prevention |
Among adults with a history of myocardial infarction |
Does adherence to a Mediterranean diet |
Lower risk of a second myocardial infarction |
Compared to those who do not adopt a Mediterranean diet? |
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.