Evidence-based answers to clinical questions are the foundation of patient care decisions and recommendations. Consider whether the clinical question you develop is a background question to establish the state of the evidence on a topic (with no comparison group) or a foreground question to compare specific interventions or modalities.
Imagine you wish to recommend your patient for a clinical trial. What important criteria make this patient a candidate for the clinical trial you imagine?
| PICO Component | Tips for Building Question | Example | |
|---|---|---|---|
| P | Patient population or problem |
How would I describe this group of patients? Balance precision with brevity. |
In patients with heart failure from dilated cardiomyopathy who are in sinus rhythm . . |
| I | Intervention (a cause, prognostic factor, treatment, etc.) |
Which main intervention is of interest? Be specific. |
. . . would adding anticoagulation with warfarin to standard heart failure therapy . . . |
| C | Comparison intervention (if necessary) |
What is the main alternative to be compared with the intervention? Be specific. |
. . . when compared with standard therapy alone . . . |
| O | Outcomes (measurable) |
What do I hope the intervention will accomplish? What would this exposure really effect? Be specific. |
. . . lead to lower mortality or morbidity from thromboembolism? Is this enough to be worth increased risk of bleeding? |
Not all patient scenarios will fit every component of the PICO pneumonic. There are other conceptual pneumonics that could work better for answering your question. The important thing is to develop a clinical question that includes only important concepts that contribute toward answering the question.
If concepts that describe patient or caregiver perspective, context or environment are important to include, then the scenario and question may necessitate a different kind of research method, perhaps a qualitative research question and approach may be better.