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Evidence-Based Medicine: Cinical Questions & PICO

What is PICOT?

patient or problem

  • What are the characteristics of the patient or population?
  • What is the condition or disease you are interested in?

intervention

  • What do you want to do with this patient (e.g. treat, diagnose, observe)?

comparison

  • What is the alternative to the intervention (e.g. placebo, different drug, surgery)?

outcome

  • What are you trying to accomplish, measure, improve or affect (e.g. relieving or eliminating specific symptoms, improving or maintaining function)?
  • Outcomes should be measurable.

type of study / time

  • Do you need a systematic review or a case study?
  • What type of foreground question are you trying to answer (e.g., therapy, diagnosis, harm, prognosis, prevention)?
  • What is your timeframe, or the period over which an outcome is to be measured?

How to Use the PICO Method to Form a Clinical Question

Clinical questions generally fall into one of two categories:  background questions and foreground questions.

Background questions are considered general knowledge questions and typically ask whowhatwherewhen or how and with regards to a disorder, test, treatment, etc.

Example:  What causes migraines?

Foreground questions ask for specific knowledge to inform clinical decisions, and typically concern a specific patient or population.  These questions tend to be more specific and complex compared to background questions and can include the type of study or methodology.

Example:  Do Botox injections prevent migraines in adults who suffer from chronic migraines?

Foreground questions can be further divided into four major types:

  • Therapy:  Questions of treatment in order to achieve a specific outcome.  These questions may include drugs, surgical intervention, change in diet, counseling, etc.
  • Diagnosis:  Questions of identification of a disorder in a patient presenting with specific symptoms.
  • Prognosis:  Questions of progression of a disease or likelihood of a disease occurring.
  • Etiology/Harm:  Questions of negative impact from an intervention or other exposure.

Your next patient is a 72-year-old woman with osteoarthritis of the knees and moderate hypertension, accompanied by her daughter, a lab technician from the hospital.  The daughter wants you to give her mother a prescription for one of the new COX-2 inhibitors because she has heard that they cause less GI bleeding.  Her mother is concerned that the new drugs will mean more out-of-pocket costs each month.

Patient / Problem Intervention Comparison Intervention Outcome(s)
72-year-old woman with osteoarthritis of the knee and moderate hypertension COX-2 inhibitor other NSAIDS

less GI bleeding; pain control

A well-written, clinical question would be:

In a 72-year-old woman with osteoarthritis of the knee, can COX-2 inhibitor use decrease the risk of GI bleeding compared to other NSAIDS?

You have been treating a 54-year-old woman for many years and despite the excellence of your fixed partial denture restorations, the intense routine maintenance by her periodontist, and good home care, she has been experiencing a continued deterioration of her periodontal tissues. Her attempts to quit smoking have been unsuccessful; otherwise she is in good health and taking no medications. Because you are her primary care dentist, she has questioned you about her current dilemma. The periodontist has suggested a 3-week course of doxycycline therapy to control her latest exacerbation of periodontal disease, but she is concerned about Food and Drug Administration (FDA) reports asking for prudent use of antibiotics. How do you advise this patient?

Patient / Problem Intervention Comparison Intervention Outcome(s)
54-year-old woman with exacerbation of periodontal disease doxycycline no treatment less gum bleeding; stop recession

A well-written, clinical question would be:

For a 54-year-old woman with periodontal disease, how effective is the therapeutic use of doxycycline decrease gum bleeding and recession compared to no treatment?

PICO Tools