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Evidence Based Practice: Asking the Question

Steps to Asking the Clinical (PICO) Question

Anatomy of a good clinical question

PICO is an acronym for the elements of a good question. (See below for explanations of its parts.)

Patient or problem

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.

Intervention, prognostic factor, or 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?

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.

Outcomes

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?

Patient Case Example and Clinical Question

Scenario 1: Ms. Crosbie has been asked to schedule an appointment for her baby's 18 month needle (MMR). She is very concerned about this as she has heard reports that the MMR needle causes autism. She asks you whether or not there is a link between the MMR vaccine and an increased risk of autism in children?
P - 18 month old child
I - MMR vaccine
C - no MMR vaccine
O - autism / autistic spectrum disorder

Answerable question: In 18 month old children, does receiving the MMR vaccine increase the risk of developing autism?

Scenario 2: A 40 year old woman is hospitalized with severe depression. Might the addition of group psychotherapy improve her outcomes?
P – middle-aged woman hospitalized with severe depression
I – Group psychotherapy
C – Usual care (pharmacotherapy)
O – improve symptoms and shorten hospital stay

Answerable question: In hospitalized patient with severe depression, will group psychotherapy improve symptoms and shorten hospital stay?

KINDS OF CLINICAL QUESTIONS

Therapy

Diagnosis

Harm

Prognosis

CREDIT

The material on this page comes from Amanda Avery's EBM Lib Guide at The Commonwealth Medical College Library in Scranton, PA.