PICO(T) is a mnemonic used to describe the four elements of a good clinical foreground question:
P = Population/Patient/Problem - How would I describe the problem or a group of patients similar to mine?
I = Intervention - What main intervention, prognostic factor or exposure am I considering?
C = Comparison - Is there an alternative to compare with the intervention?
O = Outcome - What do I hope to accomplish, measure, improve or affect?
T = Time (if applicable) - The time frame of treatment and/or measurable outcome.
PICO is an acronym used to remember the key components of a clinical question. Physicians first developed the PICO framework in evidence-based medicine as a way to address knowledge gaps during patient encounters. Questions could arise around a patient’s diagnosis, prognosis, and therapy, as well as around prevention strategies and patient education. Since then, PICO has become the most widely used question framework for evidence-based practice.
PICO(T) is useful in academic and clinical settings. It can help you:
PICO(T) has some limitations. The framework privileges interventions, experimental research, and dominant voices.
McKenzie JE, Brennan SE, Ryan RE, Thomson HJ, Johnston RV, Thomas J. Chapter 3: Defining the criteria for including studies and how they will be grouped for the synthesis. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook This link opens in a new window.
|Element of the clinical question||
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?
Is there an alternative treatment to compare?
What is the clinical 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||in the management of fever and infection?|
|Example||Among family-members of patients undergoing diagnostic procedures||does standard care,||listening to tranquil music, or audio taped comedy routines||make a difference in the reduction of reported anxiety.|
Fill in the blanks with information from your clinical scenario:
In_______________, what is the effect of ________________on _______________ compared with _________________?
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
Does ____________ influence ______________ in patients who have _____________?
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.