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NURS 3374 - Research and Evidence-Based Practice: PICO

The Clinical Question

Most Common Type of Clinical Questions:

Therapy determining the effect of interventions on patient-important outcomes
Diagnosis establishing the power of a test to differentiate between those with and without a target condition or disease
Harm ascertaining the effects of potentially harmful agents on patient-important outcomes
Prognosis estimating a patient's future course

4 Elements of the Clinical Question (PICO) - use for therapy questions

Question/Study Design
 PICO Worksheet  PICO Tutorial

The following examples break down each element of a PICO question.

PICO - Patient

What are their most important characteristics?

  • Primary problem
  • Disease state
  • Co-existing condition

Describe your patient specifically:

  • Sex
  • Age
  • Ethnicity
  • Socioeconomic factors

ALWAYS include this piece in your search.

I - Intervention

Illustration of doctor

What do you want to do for the patient?

  • Order a test
  • Prescribe a drug
  • Order a procedure

Other considerations:

  • Main intervention
  • Prognostic factors
  • Exposures

Almost always include this piece in your search.

C- Comparison

What is the alternate intervention, if any?

  • A different drug
  • No medication
  • A Placebo
  • A different test
  • A different procedure

It is less common to include this piece in a search.

O - Outcome

What are you hoping to achieve, measure, or change for the patient?

  • Alleviate symptoms
  • Improve test results
  • Reduce adverse events
  • Improve function

Could also be the result NOT desired.

Sometimes include this piece in your search.

PICO Examples

1. Does Constraint-induced Aphasia Therapy (intervention) improve aphasia (outcome) in stroke patients (patient)?

2. In kindergarteners (patient), is individual pull-out treatment (intervention) more effective than group pull-out treatment (comparison) for improving articulation disorders (outcome)?