Focusing Questions with PICO
The PICO mnemonic helps define questions to address specific clinical issues and aids in finding relevant evidence in the literature. Create your own PICO questions with this PICO worksheet.
Patient or Problem
How would I describe a group of patients similar to mine?
Intervention, Exposure, or Prognostic Factor
What is the main intervention, exposure, or prognosis being considered?
What is the main alternative being considered, if any?
What can I hope to accomplish, measure, improve, affect?
More on Asking Questions
- Types of Questions
How to select treatments to offer our patients that do more good than harm
How to select and interpret diagnostic tests in order to confirm or exclude a diagnosis
How to estimate a patient's likely clinical course over time due to factors other than interventions
How to identify causes for disease
How to reduce the chance of disease by identifying and modifying risk factors; how to diagnose disease early by screening
How to empathize with our patients’ situations, appreciate the meaning they find in the experience and understand how this meaning influences their healing
- Appropriate Study Design by Question Type
Question Type Appropriate Study Design Therapy Randomized controlled trial Diagnostic Test Independent, blind comparison to the gold standard Prognosis Cohort study > case-control study > case series Harm/Etiology Randomized controlled trial > cohort study > case-control study > case series Prevention Randomized controlled trial > cohort study > case-control study > case series
For each of the question types above, a systematic review or meta-analysis is better than an individual study. A systematic review will compare several approximately designed studies and aggregate the results.
- Background vs. Foreground Questions
Background questions are more general questions that often begin with what, when, where, why, or how. Some examples include:
- How do you diagnose...?
- How do you treat...?
- What are the risk factors for…?
- What is the prognosis for…?
With questions like this, you are not asking about specific tests, treatments, risk or prognostic factors but are more generally asking about the best among all possibilities. You are often acknowledging that you may not know a lot about a particular subject and need some general background information to get started. These are questions most appropriately answered by textbooks or online references like DynaMed Plus or UpToDate. They are too general for the primary research literature to address and therefore aren’t good questions for searching databases like PubMed or Ovid Medline.
Foreground questions are more specific questions often defined by the PICO mnemonic. They require a specific named intervention and comparison, which makes them good questions for the searching the primary research literature using databases such as PubMed or Ovid Medline. Foreground questions are also referred to as clinical questions.