Using PICO to Formulate Clinical Questions

PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. It stands for:

P–Patient/Problem
I–Intervention
C–Comparison
O–Outcome

Many people find that it helps them clarify their question, which in turn makes it easier to find an answer. 

Use PICO to generate terms – these you’ll use in your literature search for the current best evidence.   Once you have your PICO terms, you can then use them to re-write your question.  (Note, you can do this in reverse order if that works for you.)

Example:

Often we start with a vague question such as, “How effective is CPR, really?”  But, what do we mean by CPR?  And how do we define effective?  PICO is a technique to help us – or force us – to answer these questions.   Note that you may not end up with a description for each element of PICO. 

P –  our question above doesn’t address a specific problem other than the assumption of a person who is not breathing. So, ask yourself questions such as, am I interested in a specific age cohort? (Adults, children, aged); a specific population (hospitalized, community dwelling); health cohort (healthy, diabetic, etc.)   

I – our question above doesn’t have a stated intervention, but we might have one in mind such as ‘hands-only’

C – Is there another method of CPR that we want to compare the hands-only to?  Many research studies do not go head to head with a comparison.  In this example we might want to compare to the standard, hands plus breathing

O – Again, we need to ask, what do we mean by ‘effective’?  Mortality is one option with the benefit that it’s easily measured. 

Our PICO statement would look like:

From our PICO, we can write up a clearer and more specific question, such as:

 In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?