It is not always easy to search for the best answer to a clinical question simply by typing it into a search engine. Clinicians often want to know what the ‘best’ treatment is that will work the ‘fastest’ with the ‘fewest’ side effects possible, but searching using these kinds of terms is not very efficient.
By carefully defining the PICO elements of our clinical question, we can more effectively search the literature, and find articles that will answer our specific question.
The PICO framework is commonly used to formulate the clinical question. Each of the 4 letters identifies a key component of 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? (May be just the status quo) |
| 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.
Sometimes this is expanded to PICOTT, which adds on extra letters for:
T Type of Question - Such as a diagnosis, prognosis, therapy, aetiology/harm, or prevention question
T Type of Study - Includes the study design that would best answer the question: randomised controlled trial; cohort study; case controlled study; case series; case report etc. See also Levels of Evidence.
There's a good outline of this, including some self-testing, on the National Library of Medicine's PubMed information site: Using PICO to frame clinical questions.
You won't need to use every element of the PICO as concepts to search. Often there is no C (Comparison) and the Outcome will come out of the results of your search.
There are many other frameworks that can be used for different types of questions e.g. PCC and SPIDER. You should use the framework that best suits your type of question. Discussion and examples are in the other frameworks section.
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 is useful in academic and clinical settings. It can help you:
PICO has some limitations. The framework privileges interventions, experimental research, and dominant voices.
A young, non-pregnant woman with iron deficiency anaemia has developed GI side effects on ferrous sulfate. A friend has mentioned to her that Maltofer iron preparation has fewer side effects. She would like your advice on whether this might be a suitable option for treatment of her iron deficiency anaemia.
PICO question: Is iron hydroxide polymaltose as effective at treating iron deficiency anaemia in non-pregnant women as ferrous sulfate and does it have a lower incidence of GI side effects.
| Population | Intervention | Comparison | Outcome(s) | |
|---|---|---|---|---|
| Definition | Young non-pregnant women with uncomplicated iron deficiency anaemia. | Oral iron hydroxide polymaltose at usual recommended dosing for treatment of anaemia | Oral ferrous sulfate, at usual recommended dosing for the treatment of anaemia |
Effective treatment of anaemia, measured by change in Hb levels and/or ferritin levels. Incidence of GI side effects. |
Asking clinical questions - an excellent module you can work through from the Clinical Information Access Portal (CIAP), NSW Health.
Evidence-Based Medicine in Practice - Professor Paul Glasziou from the University of Oxford's Centre for Evidence-Based Medicine (CEBM) talks about forming a PICO question.
Evidence-Based Practice: Step 1: Ask the Question (PICO) - Includes information on the different types of questions. (From the Medical University of North Carolina Libraries)
Evidence-Based Practice: What Type of Question - Information on PICO and SPIDER but also on other ways of structuring a research or clinical question. (From the University of Notre Dame Library, Australia)
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 - This article looks at using PICO and SPIDER as tools to help in literature searching.
PICO for Evidence-Based Medicine (University of Sydney) (2:08)
Talks about PICO as a "mnemonic" for breaking a research question down into distinct concepts that can be used in searching.
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