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Nursing Resource Guide

PICO

Write a PICO question when you are asking foreground questions, not background questions. 

  • Background questions are usually informational questions about a topic and do not require the PICO framework to answer.
  • Foreground questions look for answers to specific patients, problems, types of interventions, and clinical outcomes, and the PICO framework will work well with these questions.

Use PICO to write a clear, researchable clinical question. The four elements of PICO break a research topic into searchable keywords and make locating evidence-based practice research sources easier. 

PICO is an acronym for: 

  • P: Patient, population, or problem
  • I: Intervention, prognostic factor or exposure 
  • C: Comparison or intervention (if appropriate)
  • O: the Outcome to measure or achieve

PICO may sometimes include these additional letters. Use these to make your search even more specific:

  • T: Timeframe
  • T: Type of Study
  • S: Setting

PICO questions are written differently for the below clinical question types. 

Clinical Question Types:

  • Therapy/Intervention: Questions that examine the effectiveness of interventions (i.e. treatment) in improving outcomes in patients. This is the most common type of clinical question. 
  • Etiology/Harm: Questions that evaluate negative impacts from an intervention or exposure, or research the cause of a problem.
  • Diagnosis/Diagnostic Test: Questions that analyze the use of a test to identify a disorder or predict a disease.
  • Prevention: Questions that examine the use of medication or other intervention in the prevention of a disease or condition.
  • Prognosis/Predictions: Questions that examine the progression of a disease or likelihood of a disease occurring.
  • Meanings: Questions that examine a patient's perceptions.

See the next tab for PICO question templates.

Enter words from your topic in these templates.  Your PICO question should fit only one type of question in the list.

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Prevention:

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Prognosis/Predictions

In__________ (P) how does ________ (I) compared to _______(C) influence _______ (O) over ______ (T)?

Meaning

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

 

See the next tab for PICO question examples for each clinical question type.

Templates from Sonoma State University and Southern Illinois University Edwardsville.

Review these PICO questions to learn how to write a clinical PICO question.

PICO Therapy/Intervention Question Example: 

In school-age children, what is the effect of a school-based physical activity program on a reduction in the incidence of childhood obesity compared with no intervention within a 1 year period?

PICO Research Question Elements Keyword Examples
P School-age children Children, school-age
I School-based physical activity program Activity program, physical education
C No intervention
O Reduced risk of obesity Obesity, weight management
T 1 year period Year, one year

PICO Therapy/Intervention Question Example: 

In a premenopausal female with estrogen receptor positive (ER+) breast cancer, does the use of tamoxifen compared to no hormonal therapy decrease the risk of reoccurrence of breast cancer? ​

PICO Research Question Elements Keyword Examples
P Premenopausal Female with estrogen receptor positive (ER+) breast cancer  Adult, female, estrogen receptor positive, ER+
I Tamoxifen Tamoxifen
C No hormonal therapy Hormonal therapy
O Decreased risk of breast cancer reoccurrence Breast cancer reoccurrence 

PICO Etiology Question Example: 

Are males 50 years of age and older who have a history of 1 year of smoking or less at an increased risk of developing esophageal cancer compared with males age 50 and older who have no smoking history?

PICO Research Question Elements Keyword Examples
P Males 50 years or older Males, men, adult, 50 years old
I One year of smoking Smoking
C No smoking history
O Increased risk of developing esophageal cancer Esophageal cancer, esophagus

PICO Etiology Question Example: 

Are women ages 25-40 who take oral contraceptives at greater risk for developing blood clots compared with women ages 25-40 who use IUDs for contraception over a 5 year time frame?

PICO Research Question Elements Keyword Examples
P Women aged 25-40 Women, woman, female, adult, 25-40 years old
I Oral contraceptives Oral contraceptives, birth control
C IUDs for contraception IUD, IUDs
O Greater risk for developing blood clots Blood clots
T 5 year time frame

PICO Diagnosis/Diagnostic Test Question Example: 

Is a yearly mammogram more effective in detecting breast cancer compared with a mammogram every 3 years in women under age 50?

PICO Research Question Elements Keyword Examples
P Women under age 50 Women, woman, female, 50 years old
I Yearly mammogram Mammogram, yearly
C Mammogram every three years Mammogram
O Effectiveness of detecting breast cancer Breast cancer, detection, diagnosis

PICO Diagnosis/Diagnostic Test Question Example: 

Is a colonoscopy combined with fecal occult blood testing more accurate in detecting colon cancer compared with a colonoscopy alone in adults over age 50?

PICO Research Question Elements Keyword Examples
P Adults over age 50 Adults, adult, over 50 years old
I Fecal occult blood testing and colonoscopy Fecal occult blood testing, fecal blood testing, colonoscopy
C Colonoscopy Colonoscopy
O Detecting colon cancer Colon cancer, detection, diagnosis

PICO Prevention Question Example: 

For women under age 60, does the daily use of 81mg low-dose Aspirin reduce the future risk of stroke  compared with no usage of low-dose Aspirin?

PICO Research Question Elements Keyword Examples
P Women under age 60 Women, female, adult, over age 60
I Daily use of 81mg low-dose Aspirin low-dose Aspirin
C No usage of low-dose Aspirin low-dose Aspirin
O Reduce the future risk of stroke Stroke, stroke risk

PICO Prevention Question Example: 

For adults over age 65 does a daily 30 minute exercise regimen reduce the future risk of heart attack compared with no exercise regimen?

PICO Research Question Elements Keyword Examples
P Women over age 65 Women, female, adult, over age 65
I Daily 30 minute exercise regimen Exercise, 30-minute exercise routine
C No exercise regimen No exercise
O Reduce the future risk of heart attack Heart attack, heart attack risk

PICO Prognosis/Predictions Question Example: 

Does daily home blood pressure monitoring influence compliance with medication regimens for hypertension  in adults over age 60 who have hypertension during the first year after being diagnosed with the condition?

PICO Research Question Elements Keyword Examples
P Adults over age 60 who have hypertension Adults, hypertension, over age 60
I Daily home blood pressure monitoring Blood pressure, blood pressure monitor
C N/A N/A
O Compliance with medication regimens for hypertension Hypertension medication 
T During the first year after being diagnosed with the condition Newly diagnosed, hypertension

PICO Prognosis/Predictions Question Example: 

Does monitoring blood glucose 4 times a day improve blood glucose control in people with Type 1 diabetes during the first six months after being diagnosed with the condition?

PICO Research Question Elements Keyword Examples
P People with Type 1 diabetes Type 1 diabetes, adult, child, teenager
I Monitoring blood glucose 4 times a day Blood glucose, blood glucose monitoring
C N/A N/A
O Improve blood glucose control Blood glucose control
T During the first six months after being diagnosed with the condition Newly diagnosed, Type 1 diabetes 

PICO Meaning Question Example: 

How do teenagers diagnosed with cancer perceive chemotherapy and radiation treatments during the first 6 months after diagnosis?

PICO Research Question Elements Keyword Examples
P Teenagers Teenager, adolescent 
I Diagnosed with cancer Cancer diagnosis
C N/A N/A
O Perception of chemotherapy and radiation treatments Chemotherapy, radiation treatment
T During the first six months after diagnosis Newly diagnosed, cancer

PICO Meaning Question Example: 

How do first-time mothers of premature babies in the NICU perceive bonding with their infant during the first month after birth?

PICO Research Question Elements Keyword Examples
P First-time mothers Mothers, new mother
I Mothers of premature babies in the NICU NICU, newborn, intensive care
C N/A N/A
O Perception of infant bonding Infant bonding 
T During the first month after birth  

 

Questions adapted from Southern Illinois University Edwardsville.

Use these handouts to learn more about PICO and to write your PICO. 

Evidence-based medicine (a.k.a., evidence practice) is an integrative approach to health care.  It combines clinical expertise, the best scientific evidence available, and a patient's values to make clinical decisions about individual patient care.  

Clinical Expertise Best Scientific Evidence  Patient Values
Education Relevant Patient characteristics
Skills Current Patient circumstances
Years of experience Sound methodology Patient preferences

Evidence-based resources can either be filtered or unfiltered.

Type of Source Primary Source (Unfiltered) Secondary Source (Filtered)
Purpose
  • Reports original research findings. Can include peer-reviewed sources, which have been evaluated by experts in the field before publication.
  • Examples: randomized controlled trial, case-control study or cross-sectional study.
  • Synthesizes primary research, filters, and evaluates the primary literature.
  • Examples: meta-analysis, systematic review.
Databases
  • CINAHL
  • MEDLINE/PubMed
  • Health Source (Nursing Academic)
  • CINAHL (Publication type and evidence-based practice filter available)
  • Nursing and Allied Health
  • PubMed Clinical Queries

Evidence-based resources are rated by the quality of evidence. The quality of evidence increases with the level of evaluation. As seen in the pyramid below, systematic reviews are the highest level of evidence, and background information is the lowest level of evidence. 

Use the Databases in the Databases Tab on the Left to find evidence-based practice sources.