- Active: a different drug, dose, or kind of therapy
- Inactive: placebo, standard care, no treatment
OUTCOME (optional)
Consider:
TIME (optional)
Consider:
- How much time does it take to demonstrate the clinical outcome(s)?
Design a question that incorporates the most salient piece of information from each of the above categories.
PICO Template Questions
The PICO framework is ideal for building questions that focus on comparing treatments. Other types of questions—especially those focused on prognosis, etiology, or perceptions—can be more challenging. Just remember that the Intervention portion usually represents the piece of your research you're interested in comparing or controlling; if you were designing an experiment, it would be the piece that you manipulate to see what results you'd get.
| Question Type | Patient/Problem | Intervention/Exposure | Comparison/Control | Outcome |
|---|---|---|---|---|
| Treatment (therapy) | Patient's disease or condition | Therapeutic measure (e.g., a medication, surgical intervention, lifestyle change) | Standard of care, another intervention, or placebo | Mortality rate, days absent from work, pain, disability |
| Prevention | Patient's risk factors and general health condition | Preventive measure (e.g., a medication, lifestyle change) | May not be applicable | Disease incidence, mortality rate, days absent from work |
| Diagnosis | Target disease or condition | Diagnostic test or procedure | Current "gold standard" test for the condition | Measures of the test utility (i.e., sensitivity, specificity, odds ratio) |
| Prognosis (natural history) | Main prognostic factor or clinical problem, in terms of its severity and duration | Exposure of interest is usually time (sometimes expressed as "watchful waiting") | Usually not applicable; if your question is about "watchful waiting," identify standard treatment | Survival rates, mortality rates, rates of disease progression |
| Etiology or harm (causation) | Patient's risk factors, current health disorders, or general health condition | Intervention or exposure of interest, including some indication of the strength (dose) of risk factor and the duration of exposure | May not be applicable | Disease incidence, rates of disease progression, mortality rates |
You may find it helpful to use one of the following templates when creating your PICO question. Remember, the time (T) piece is usually optional and therefore can be omitted.
Treatment (therapy) — questions addressing the treatment of an illness or disability:
In _______(P), how does _______(I) compared with _______(C) affect _______(O) within _______(T)?
In _______(P), what is the effect of _______(I) on _______(O) compared with _______(C)?
Ex 1: In African American female adolescents with hepatitis B (P), how does acetaminophen (I) affect liver function (O) compared with ibuprofen (C)?
Ex 2: In inpatient chronic schizophrenia patients (P), do social skills group training sessions (I) increase conversational skills (O) when compared with standard care (C)?
Prevention — questions addressing the prevention of a risk factor or problematic health condition:
In _______(P), does the use of _______(I) reduce the incidence [or future risk] of _______(O) compared with _______(C)?
Ex: In adult females (P), do daily vitamin C or zinc supplements (I) reduce the incidence of the common cold (O) compared with no intervention (C)?
Diagnosis — questions addressing the process of determining the nature and cause of a disease or injury through evaluation:
In _______(P) is/are _______(I) more accurate in diagnosing _______(O) compared with _______(C)?
Ex: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) more accurate in diagnosing an acute myocardial infarction (O) compared with one initial 12-lead ECG (C)?
Prognosis (natural history) — questions addressing the prediction of the course of a disease:
In _______(P) how does _______(I) compared with _______(C) influence _______(O) over/during _______(T)?
Does _______(I) influence _______(O) in patients who have _______(P) over _______(T)?
Ex 1: In patients 65 years and older (P), how does the use of an influenza vaccine (I) compared with not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?
Ex 2: In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared with being a non-smoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)?
Etiology or harm (causation) — questions addressing the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder:
Are _______(P) who have _______(I) at increased/decreased risk of _______(O) compared with those who have/do not have _______(C) over/during _______(T)?
Ex: Are 30- to 50-year-old women (P) who have high blood pressure (I) at increased risk for an acute myocardial infarction (O) compared with those without high blood pressure (C) during the first year after hysterectomy (T)?
Meaning or quality of life — questions addressing how one experiences a phenomenon:
How do _______(P) diagnosed with _______(I) perceive _______(O) compared with _______(C) during/over _______(T)?
Ex 1: How do young males (P) diagnosed with below-the-waist paralysis (I) perceive their interactions with their romantic partners (O) during the first year after their diagnosis (T)?
Ex 2: How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels to their healthcare providers (O) during their pregnancy and six weeks postpartum (T)?
Adapted from the PICOT Question Template, Ellen Fineout-Overholt, 2006. This form may be used for educational and research purposes without permission.
