PICO process explained
The PICO process (or framework) is a mnemonic used in evidence-based practice (and specifically evidence-based medicine) to frame and answer a clinical or health care related question,[1] though it is also argued that PICO "can be used universally for every scientific endeavour in any discipline with all study designs".[2] The PICO framework is also used to develop literature search strategies, for instance in systematic reviews.[3]
The PICO acronym has come to stand for:[4] [5]
- PPatient, problem or population
- IIntervention
- CComparison, control or comparator[6]
- OOutcome(s) (e.g. pain, fatigue, nausea, infections, death)
An application that covers clinical questions about interventions, as well as exposures, risk/ prognostic factors, and test accuracy, is:[7] [8]
- PPatient, problem or population
- IInvestigated condition (e.g. intervention, exposure, risk/ prognostic factor, or test result)
- CComparison condition (e.g. intervention, exposure, risk/ prognostic factor, or test result respectively)
- OOutcome(s) (e.g. symptom, syndrome, or disease of interest)
Alternatives such as SPICE and PECO (among many others) can also be used. Some authors suggest adding T and S, as follows:
PICO as a universal technique
It was argued that PICO may be useful for every scientific endeavor even beyond clinical settings. This proposal is based on a more abstract view of the PICO mnemonic, equating them with four components that is inherent to every single research, namely (1) research object; (2) application of a theory or method; (3) alternative theories or methods (or the null hypothesis); and (4) the ultimate goal of knowledge generation.
Juxtaposing PICO with universal components of all research endeavors| PICO component | Abstract component inherent to all research designs |
|---|
| Problem | Research object |
| Intervention | Application of a theory or method |
| Comparison | Alternative theories or methods (or, in their absence, the null hypothesis) |
| Outcome | Knowledge generation | |
This proposition would imply that the PICO technique could be used for teaching academic writing even beyond medical disciplines.
Examples
Clinical question: "In children with headache, is paracetamol more effective than placebo against pain?"
- Population = Children with headaches; keywords = children + headache
- Intervention = Paracetamol; keyword = paracetamol
- Compared with = Placebo; keyword = placebo
- Outcome of interest = Pain; keyword = pain
Pubmed (health research database) search strategy:children headache paracetamol placebo pain
Clinical question: "Is the risk of having breast cancer higher in symptom-free women with a positive mammography compared to symptom-free women with a negative mammography?"
- Population = Women without a history of breast cancer
- Investigated test result = Positive result on mammography
- Comparator test result = Negative result on mammography
- Outcome of interest = Breast cancer according to biopsy (or not)
Notes and References
- Huang X, Lin J, Demner-Fushman D . Evaluation of PICO as a knowledge representation for clinical questions . AMIA Annu Symp Proc . 359–63 . 2006 . 2006 . 17238363 . 1839740 .
- Nishikawa-Pacher . Andreas . Research Questions with PICO: A Universal Mnemonic . Publications . 2022 . 10 . 3 . 21 . 2304-6775 . 10.3390/publications10030021 . free .
- Schardt C, Adams MB, Owens T, Keitz S, Fontelo P . Utilization of the PICO framework to improve searching PubMed for clinical questions . BMC Med Inform Decis Mak . 7. 16 . 2007 . 17573961 . 1904193 . 10.1186/1472-6947-7-16 . free .
- Web site: 17 November 2004. Asking a Good Question (PICO). dead. https://web.archive.org/web/20110226210556/http://www.usc.edu/hsc/ebnet/ebframe/PICO.htm. 2011-02-26. 2010-05-18.
- Richardson. WS. 1995. The well-built clinical question: a key to evidence based-decisions. ACP Journal Club. 123, 3. 3 . A12–A13. 10.7326/ACPJC-1995-123-3-A12 .
- Web site: Chapter 2. Systematic Review Methods -- AHRQ Technical Reviews and Summaries -- NCBI Bookshelf . March 2009 . Agency for Healthcare Research and Quality (US) . 2010-05-18.
- Richardson. WS. 1995. The well-built clinical question: a key to evidence based-decisions. ACP Journal Club. 123, 3. 3 . A12–A13. 10.7326/ACPJC-1995-123-3-A12 .
- Luijendijk HJ . How to PICO questions about medical tests . BMJ Evidence-Based Medicine. 2021 . 26 . 4 . 155–157 . 10.1136/bmjebm-2021-111676 . 8311106 . 33789913 . free .
