A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. PICO makes this process easier. It is a mnemonic for the important parts of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.
Most clinical encounters lead to a need for information. The first step in EBM is to translate the need for information into a question that can be answered by clinical research.
There are "foreground" questions and "background" questions.
Background questions:
Foreground questions:
The four parts of an answerable foreground question are PICO:
Questions might investigate: prevention, cost-effectiveness, quality of life, clinical findings, prognosis, aetiology, or therapy, among others. The question asked determines the types of evidence searched.
Who is the patient?
What are their most important characteristics?
Describe your patient specifically:
ALWAYS include this piece in your search.
What do you want to do for the patient?
Other considerations:
Almost always include this piece in your search.
What is the alternate intervention, if any?
Is there comparative research on treatment options?
What would you do if you did not take the steps you plan to?
It is less common to include this piece in a search
What are you hoping to achieve, measure, or change for the patient?
Could also be the result NOT desired.
What result or outcome do you think is realistic?
What outcomes are reported in the literature for different treatment options?
Sometimes include this piece in your search.
Therapy:
In children with spastic cerebral palsy (P), what is the effect of splinting and casting (I) compared to constraint-induced therapy (C) on two-handed skill development (O)?
Diagnosis:
In middle-age males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnossing an accute myocardial infarction (O)?
Prognosis:
1. For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pnemonia (O) during flu season?
2. In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared to a non-smoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction?
Etiology:
Are 30- to 50-year old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy?
How to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
In _____P_______, what is the effect of ______I______ on
_____O______ compared with _______C_________?
How to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
Are (Is) ____I______more accurate ___O_____in diagnosing __P__
compared with ____C__?
How to estimate a patient's likely clinical course over time due to factors other than interventions
Does _____I____ influence _____O______ in patients
who have _______P_____ ?
How to identify causes for disease (including its iatrogenic forms).
Are _____P________ who have ___________P_____ at ______O_____
(increased/decreased) risk for/of _____I______ compared with
______P_______with/without _____C______?
Clinical findings: how to properly gather and interpret findings from the history and physical examination.
Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.
