Evidence-Based Practice: ASK - PICO
This guide is designed to assist health care professionals to become effective and efficient users of the medical and nursing literature.
Evidence-Based Practice: Navigation
EBP Home | Pre-Reqs: Before you Dive in ... Learn About the Medical Literature | Introduction to EBP in 6 Steps | AJN's EBP Series | ASK - PICO | Levels of Evidence and Study Designs | SEARCH EBP Tools & Pyramid | EBP Tools Table | Literature Review | Getting to Fulltext | APPRAISE-Critical Appraisal | DISSEMINATE - Writing for Publication
Other EBP Guides, Tutorials, Terms | RN Residency Teaching Activities | How to Identify Peer-Reviewed Journals
PICO Tools
* The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process. [Article]
* How to Create a Well-Built Clinical Question - from NLM
* PICO and Search Query Worksheet [pdf] from Ebling Library - University of Wisconsin-Madison
Background vs. Foreground Questions
When to use PICO ...
Background questions concern general knowledge. These types of questions generally have only 2 parts:
1) A question root (who, what, when, where, how, why) and
2) a disorder, test, treatment, or other aspect of health care.
Often these questions can best be answered by using a textbook or consulting a clinical database.
Example Background Question: What are the best interventions to prevent accidental falls in the elderly?
Foreground questions are specific knowledge questions that affect clinical decisions, including a broad range of biologic, psychological, and sociologic issues. These are the questions that generally require a search of the primary medical literature and that are best suited to the PICO format.
PICO Search
PICO
What is the P.I.C.O. Model?
Defining a clinical question in terms of the specific patient problem aids the searcher in finding clinically relevant evidence in the literature.
Essentially, PICO is a focused search strategy.
P-I-C-O Model for Clinical Questions
| P | Patient, Population, or Problem | How would I describe a group of patients similar to mine? |
| I | Intervention, Prognostic Factor, or Exposure | Which main intervention, prognostic factor, or exposure am I considering? |
| C | Comparison or Intervention (if appropriate) | What is the main alternative to compare with the intervention? |
| O | Outcome you would like to measure or achieve | What can I hope to accomplish, measure, improve, or affect? |
| T | Time Interval | What is the time interval to achieve desired outcomes? |
| What type of question are you asking? | Diagnosis, Etiology/Harm, Therapy, Prognosis, Prevention |
|
| Type of study you want to find | What would be the best study design/methodology? |
Table based on: Evidence Based Medicine: PICO. UIC Library.
Example PICO Questions
Therapy / Intervention Example : In the elderly (P), does aspirin (I) reduce the risk of heart attacks (O)?
Intervention Example : In hospitalized adults (P), how does a Rapid Response Team (I) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a 3-month period?
Diagnosis Example : In healthcare settings, does screening for intimate partner/domestic violence (I) improve quality-of-life (O) for women (P)?
Meaning Example : How do family caregivers (P) with relatives receiving hospice care (I) receive the loss of their loved one (O) during end-of-life (T)?
Comparative Intervention / Therapy Example : In patients with dementia who are agitated (P), how does baby doll therapy (I) compared with Risperdone drug therapy (C) affect behavior outbursts (O) within 1 month (T)?
Other Question Formats for Different Types of Reviews
|
Review Type |
Aim |
Question Format |
Question Example |
|---|---|---|---|
|
Effectiveness |
To evaluate the effectiveness of a certain treatment/practice in terms of its impact on outcomes |
Population, Intervention, Comparator/s, Outcomes (PICO) [23] |
What is the effectiveness of exercise for treating depression in adults compared to no treatment or a comparison treatment? [69] |
|
Experiential (Qualitative) |
To investigate the experience or meaningfulness of a particular phenomenon |
Population, Phenomena of Interest, Context (PICo) [13] |
What is the experience of undergoing high technology medical imaging (such as Magnetic Resonance Imaging) in adult patients in high income countries? [70] |
|
Costs/Economic Evaluation |
To determine the costs associated with a particular approach/treatment strategy, particularly in terms of cost effectiveness or benefit |
Population, Intervention, Comparator/s, Outcomes, Context (PICOC) [14] |
What is the cost effectiveness of self-monitoring of blood glucose in type 2 diabetes mellitus in high income countries? [71] |
|
Prevalence and/or Incidence |
To determine the prevalence and/or incidence of a certain condition |
Condition, Context, Population (CoCoPop) [15] |
What is the prevalence/incidence of claustrophobia and claustrophobic reactions in adult patients undergoing MRI? [72] |
|
Diagnostic Test Accuracy |
To determine how well a diagnostic test works in terms of its sensitivity and specificity for a particular diagnosis |
Population, Index Test, Reference Test, Diagnosis of Interest (PIRD) [16] |
What is the diagnostic test accuracy of nutritional tools (such as the Malnutrition Screening Tool) compared to the Patient Generated Subjective Global Assessment amongst patients with colorectal cancer to identify undernutrition? [73] |
|
Etiology and/or Risk |
To determine the association between particular exposures/risk factors and outcomes |
Population, Exposure, Outcome (PEO) [17] |
Are adults exposed to radon at risk for developing lung cancer? [74] |
|
Expert opinion/policy |
To review and synthesize current expert opinion, text or policy on a certain phenomena |
Population, Intervention or Phenomena of Interest, Context (PICo) [18] |
What are the policy strategies to reduce maternal mortality in pregnant and birthing women in Cambodia, Thailand, Malaysia and Sri Lanka? [75] |
|
Psychometric |
To evaluate the psychometric properties of a certain test, normally to determine how the reliability and validity of a particular test or assessment. |
Construct of interest or the name of the measurement instrument(s), Population, Type of measurement instrument, Measurement properties [31, 32] |
What is the reliability, validity, responsiveness and interpretability of methods (manual muscle testing, isokinetic dynamometry, hand held dynamometry) to assess muscle strength in adults? [76] |
|
Prognostic |
To determine the overall prognosis for a condition, the link between specific prognostic factors and an outcome and/or prognostic/prediction models and prognostic tests. |
Population, Prognostic Factors (or models of interest), Outcome |
In adults with low back pain, what is the association between individual recovery expectations and disability outcomes? [77] |
|
Methodology |
To examine and investigate current research methods and potentially their impact on research quality. |
Types of Studies, Types of Data, Types of Methods, Outcomes [39] (SDMO) |
What is the effect of masked (blind) peer review for quantitative studies in terms of the study quality as reported in published reports? (question modified from Jefferson 2007) [40] |