The first step in the evidence-based practice process is to formulate a clinical question.
The clinical question should be relevant to the patient or the problem and formulated in such a way as to help with the search for an answer.
The PICO concept is commonly used to formulate the clinical question. Each of the 4 letters identifies a key concept that needs to be in research articles that will answer the question:
| P | Patient/Population/Problem | Start with the patient, or group of patients, or problem. |
| I | Intervention | What is the proposed intervention? |
| C | Comparison | What is the main alternative, to compare with the intervention? |
| O | Outcome | What is the anticipated or hoped-for outcome? |
PICO is commonly used when one intervention is being compared with another, or with no intervention at all.
Here is a dental example of a clinical problem formulated using PICO:
Do children who chew xylitol gum develop fewer dental caries than children who don't chew xylitol gum?
| P | Children |
| I | Xylitol gum |
| C | No xylitol |
| O | Decrease in incidence of caries |
Library Guides
Includes information on PICO, question types, and study types (Duke University Medical Center Library & Archives)
Includes the different types of questions (Medical University of North Carolina)
Information on PICO and SPIDER but also on other ways of structuring a research or clinical question (University of Notre Dame, Australia)
Articles
Looks at using PICO and SPIDER as tools to help in literature searching.
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938
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