P I C O |
Ask yourself: |
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Population (patient/condition) |
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease. |
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Intervention (drug, procedure, diagnostic test, exposure) |
Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient? Age? Co-existing problems? What was the patient exposed to? Asbestos? Cigarette smoke? |
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Comparison |
What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question does not always need a specific comparison. |
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Outcome |
What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores? |
Most common types of questions are related to clinical tasks:
DIAGNOSIS
Differential Diagnosis – when considering the possible causes of a patient’s clinical problem, how to rank them by likelihood, seriousness and treatability
Diagnostic Testing – 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
THERAPY – how to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them
PROGNOSIS – how to estimate the patient’s likely clinical course over time and anticipate likely complications of disease
HARM/ETIOLOGY – how to identify causes for disease (including iatrogenic forms)
Clinical examination – how to properly gather and interpret findings from the history and physical examination
Prevention – how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose early by screening
Cost-Analysis – how to compare the cost and consequences of different treatments and tests