The PICO framework is commonly used in Evidence-Based Practice to structure clinical questions. Evidence-based practice requires that clinicians use the best research they can find to help them in decision-making.
Clinicians must ask a well-designed clinical question with all the elements leading to finding relevant research literature.
This guide introduces the PICO question framework for evidence-based practice. It explores PICOs, purpose, and limitations and provides example questions across health professions.
What is the PICO model?
PICO is a model used by clinicians to phrase clinical questions during research. The components of the PICO model are not clinical question types themselves. The main aim of a PICO model is to help create an answerable question from a clinical scenario that you can use as search terms when conducting your literature review. It has been proven that clinical guidelines based on meta-analyses and systematic reviews provide the best answers to clinical questions.
What does PICO stand for in qualitative research?
A PICO question includes the following 4 areas.
· P (Patient, Problem, or Population) - Who are the relevant patients? What is the specific characteristic of the patient population important? Age, sex, geographic location, etc.
· I (Intervention) - What management strategy, prognostic factor, or exposure are you interested in?
· C (Comparison) - Is there a comparison concept or control group that you would like to consider? Not all questions include this concept.
· O (Outcome) - What are you trying to accomplish, measure, improve or affect?
· T (Timeframe), Type of Study, or Type of Question. In some questions,
How do you make a PICO question?
Pico questions are formulated based on a structure. The structure includes the population, intervention, comparison, and outcome. In addition, sometimes time is added to the PICO framework to help find a specific level of evidence. The following is the basic structure that is followed in a PICO research question.
· In POPULATION, does INTERVENTION as compared to COMPARISON/CONTROL GROUP result in OUTCOME?
or
· In POPULATION, does INTERVENTION as compared to COMPARISON/CONTROL GROUP result in OUTCOME within TIME?
What are examples of Pico questions?
Intervention/Therapy:
In school-age children (P), what is the effect of a school-based physical activity program (I) on a reduction in the incidence of childhood obesity (O) compared with no intervention (C) within 1 year (T)?
In high school children (P), what is the effect of a nurse-led presentation on bullying (I) on a reduction in reported incidences of bullying (O) compared with no intervention (C) within a 6-month time frame (T)?
Etiology:
Are males 50 years of age and older (P) who have a history of 1 year of smoking or less (I) at an increased risk of developing esophageal cancer (O) compared with males age 50 and older (P) who have no smoking history (C)?
Are women ages 25-40 (P) who take oral contraceptives (I) at greater risk for developing blood clots (O) compared with women ages 25-40 (P) who use IUDs for contraception (C) over a 5-year time frame (T)?
Diagnosis/Diagnostic Test:
Is a yearly mammogram (I) more effective in detecting breast cancer (O) compared with a mammogram every 3 years (C) in women under age 50 (P)?
Is a colonoscopy combined with fecal occult blood testing (I) more accurate in detecting colon cancer (O) compared with a colonoscopy alone (C) in adults over age 50 (P)?
Prevention:
For women under age 60 (P), does the daily use of 81mg low-dose Aspirin (I) reduce the future risk of stroke (O) compared with no usage of low-dose Aspirin (C)?
For adults over age 65 (P), does a daily 30-minute exercise regimen (I) reduce the future risk of heart attack (O) compared with no exercise regimen (C)?
Prognosis/Predictions:
Does daily home blood pressure monitoring (I) influence compliance with medication regimens for hypertension (O) in adults over age 60 who have hypertension (P) during the first year after being diagnosed with the condition (T)?
Does monitoring blood glucose 4 times a day (I) improve blood glucose control (O) in people with Type 1 diabetes (P) during the first six months after being diagnosed with the condition (T)?
Examples of PICO in dental hygiene?
· In adults over 65 years (P), how does flossing (I) compared to an electric toothbrush (C) affect the development of periodontal disease (O) within ten years (T)
· For patients undergoing orthodontic treatment (P), does the use of chlorhexidine (I) reduce the future risk of oral ulcers (O) compared with no use of chlorhexidine (C)
· Are children (P) who have cleft palate (I) increasing the risk of dental cavities (O) compared with children (P) without cleft palate (C) before the age of seven?
· Is a proteomic analysis of Gingival crevicular fluid (I) more accurate (O) in diagnosing periodontal disease (P) compared with traditional methods (C)
The Purpose of PICO
PICO is useful in academic and clinical settings. It can help you:
· form a question that focuses on the most important issue for a patient or a population
· identify key terms to use in a search for evidence
· select results that directly relate to the situation
Limitations of PICO
Some of the disadvantages of using PICO are;
· PICO privileges research that is experimental or observational. The structure privileges interventions, experimental research, and dominant voices. It does not account for complexities like considering feasibility, context, and sociocultural acceptability
· Using PICO to frame literature search terms may prove successful for questions with dominant populations and result in evidence gaps for non-dominant populations and exclude the voices of minority populations and the interests of those in non-dominant populations.
· You can expand your background question to include more voices by conducting database searches that reflect a global perspective
· Expand beyond peer-reviewed journal literature to include dissertations, reports, blogs, social media, websites, and others.
· Experiment with broadening your PICO elements, such as by including a larger population
Conclusion
PICO worksheets will help you clarify your clinical question by asking you to think specifically about the clinical scenario you want to investigate. PICO guide questions helps in determining the resource to access to answer the question and giving the most appropriate evidence-based medicine.
