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PICO: Model for Clinical Questions

Article  in  Evidence-Based Medicine · August 2018

DOI: 10.4172/2471-9919.1000115

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DOI: 10.4172/2471-9919.1000115

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Editorial Open Access

PICO: Model for Clinical Questions

Leonardo R*
Department of Clinical Research, Federal University of Uberlandia, Brazil

Introduction • Clinical findings: how to properly

gather and interpret findings from the
The PICO process is a technique used in evidence-based history and physical examination.
practice to frame and answer a clinical question in terms of • Clinical manifestations of
disease: knowing how often and
the specific patient’s problem that helps clinically relevant when a disease causes its clinical
for evidence in the literature (Table 1 and Figure 1) [1-5]. manifestations and how to use
The process of finding an appropriate response to the doubt that arises this knowledge in classifying our
patients' illnesses.
in patient care depends on how we structure the relevant parts of this • Differential diagnosis: when
methodology. The recommended form is known by the acronym considering the possible causes of
PICO. That is formed by P of patient or population, I of intervention our patient’s clinical problem, how to
select those that are likely, serious and
or indicator, C of comparison or control and O of “outcome”, which responsive to treatment.
means clinical outcome, result, or, finally, the response that is expected Other Question Types • Qualitative: how to empathize with
to be found in the sources of scientific information. Well-formulated our patients’ situations, appreciate the
meaning they find in the experience
questions should contain information about the patient [1], some and >understand how this meaning
exposure (to a treatment, a diagnosis or agent) [2] and an outcome of influences their healing
interest [3]. Clinical outcomes are the variables that will be studied. It • Self-improvement: how to keep up to
date, improve my clinical and other skills
can be illness, cure, and better in quality of life, death or limitation [6-13]. and run a better, more efficient clinical
practice.
P Patient, Population, or How would I describe a group of patients similar • Experience and meaning: (for
Problem to mine? (e.g., age, disease/condition, gender) qualitative research) how to empathize
Which main intervention, prognostic factor, or with our patients’ situations, appreciate
Intervention, the meaning they find in the experience
exposure am I considering?
I Prognostic Factor, or and understand how this meaning
(e.g., drug or other treatment, diagnostic/
Exposure influences their healing.
screening test)
What is the main alternative to compare with the Table 1: PICO process.
Comparison or
intervention?
C Intervention (if
(e.g., placebo, standard therapy, no treatment, This is a necessary condition for our search to be successful;
appropriate)
the gold standard) the second is to find the keywords that best describe each of these
Outcome you would
What can I hope to accomplish easure, improve, four characteristics of the question. Without this care, searches in
O or affect? computerized databases usually result in a lack of information or a very
like to measure or
(e.g., reduced mortality or morbidity, improved
achieve
memory, accurate and timely diagnosis) large amount of information that is not related to our interest. It is
Diagnosis, Etiology/Harm, Therapy, important to understand that all decisions begin with the formulation
Prognosis, Prevention of a clinical question and must consider the fact that taking a longer
1. What causes the problem? time, whenever possible reflecting on a real clinical situation, will only
AETIOLOGY, RISK FACTORS bring benefit to the team of professionals and especially to patient and
What type of question
2. What is the frequency of the problem?
are you asking?
FREQUENCY the society [6-13].
3. Does this person have the problem?
DIAGNOSIS
It begins with the formulation of a clinical question of interest.
4. Who will get the problem? A good question posed is the first step in starting a survey because
PROGNOSIS, PREDICTION it reduces the chances of systematic errors (biases) occurring during
Type of study you What would be the best study design/ design, planning, statistical analysis, and study completion [6-13].
want to find methodology?
• Therapy: how to select treatments to The quality of the scientific question is based on four fundamental
offer our patients that do more good items:
than harm and that are worth the efforts
and costs of using them. 1. Clinical situation (what is the disease);
• Diagnostic tests: how to select and
interpret diagnostic tests, in order to
confirm or exclude a diagnosis, based *Corresponding author: Leonardo Roever, Department of Clinical Research,
on considering their precision, accuracy, Federal University of Uberlandia, Av. Para, 1720 - Bairro Umuarama, Uberlandia
acceptability, expense, safety, etc. - MG - CEP 38400-902, Brazil, Tel: +553488039878; E-mail: leonardoroever@
Primary question
• Prognosis: how to estimate a patient's hotmail.com
types
likely clinical course over time due to
factors other than interventions Received July 29, 2017; Accepted August 01, 2018; Published August 08, 2018
• Harm / Etiology: how to identify causes
for disease (including its iatrogenic Citation: Leonardo R (2018) PICO: Model for Clinical Questions. Evid Based Med
forms). Pract 3: 115. doi: 10.4172/2471-9919.1000115
• Prevention: how to reduce the chance Copyright: © 2018 Leonardo R. This is an open-access article distributed under
of disease by identifying and modifying the terms of the Creative Commons Attribution License, which permits unrestricted
risk factors and how to diagnose use, distribution, and reproduction in any medium, provided the original author and
disease early by screening. source are credited.

Evid Based Med Pract, an open access journal

ISSN: 2471-9919 Volume 3 • Issue 2 • 1000115
Citation: Leonardo R (2018) PICO: Model for Clinical Questions. Evid Based Med Pract 3: 115. doi: 10.4172/2471-9919.1000115

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3. A comparison intervention, when applicable;

4. The clinical outcomes of interest.
The evidence-based daily clinical practice requires that we use a
large amount of knowledge, both basic and clinical. The questions then
arise in a hybrid way, being centered on patient care and on a common
scenario, involving clinical findings, etiology, differential diagnosis,
diagnostic methods, prognostic factors, therapeutic methods, patient
experience and opinion, and personal enhancement. Clinical issues
alert us to possible benefits and damages arising from patient or
medication decision-making; have in common the study of the clinical
manifestations, the symptoms and the well-being of the patient [6-13].
The knowledge of this methodology as well as their application can
benefit your patient.
References
1. Straus SE, Richardson WS, Glasziou P, Haynes RB (2010) Evidence-based
medicine: How to practice and teach it, 4th Edition. Elsevier Health Sciences.

2. Gordon G, Drummond R, Maureen OM, Deborah JC (2014) Users’ guides to

the medical literature: A manual for evidence-based clinical practice, 3rd edition.
McGraw Hill Companies, New York.

3. Xiaoli H, Jimmy L, Dina DF (2006) Evaluation of PICO as a knowledge

representation for clinical questions. AMIA Annu Symp Proc PP: 359-63.

4. Connie S, Martha BA, Thomas O, Sheri K, Paul F, et al. (2007) Utilization of

Figure 1: Study design and evidence hierarchy. the PICO framework to improve searching PubMed for clinical questions. BMC
Med Inform Decis Mak 7: 16. 

5. Jae WS, Kevin CC (2010) Observational Studies: Cohort and Case-Control

2. Intervention (what is the treatment of interest to be tested); Studies. Plast Reconstr Surg 126: 2234-2242.

6. Stillwell SB, Fineout OE, Melnyk BM, Williamson KM (2010) Evidence-based

3. Control group (placebo, sham, no intervention or other practice, step by step: asking the clinical question: a key step in evidence-
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The clinical issues focus on the knowledge about the care of patients 10. Linda SLM, Steve C (2012) EBM Guidebook. Medical Student Survival Manual
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11. https://www.aafp.org/fpm/2005/0700/p37.html
1. The patient or problem of interest;
12. https://www.dartmouth.edu/~library/biomed/guides/research/ebm-resources-
2. The main intervention, which may include an exposure, a materials.html
diagnostic method, a 13. EBP Tutorial developed by Connie Schardt ([email protected]),
Duke University Medical Center Library and Jill Mayer ([email protected]),
prognostic factor, a treatment, or both; University of North Carolina at Chapel Hill Health Sciences Library.

Evid Based Med Pract, an open access journal

ISSN: 2471-9919 Volume 3 • Issue 2 • 1000115

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