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Asking the Question - PICO

When beginning with evidence-based practice, the first step is defining the problem you are trying to solve. This is how researchers develop proposals for what they want to study. In a clinical setting, you may use this process for quality improvement, encourage practices that are evidence-based, or to develop a research study.

Writing a Focused Clinical Question

PICO(T) is a mnemonic that helps us create focused and well-built clinical questions by breaking down the information that is needed to answer a research question. 

   Patient or Population of interest / patient Problem
Who is/are the relevant patients? What are their demographics (age, sex, geographic location, important characteristics)? What is the key problem of the patient trying to be addressed? How would you describe the patients you are interested in? 


I       Intervention, Indicator, or Issue of interest, prognostic factor, exposure
What is the management strategy, diagnostic tests, or exposure being introduced or interested in? What main prognostic factor are you considering? What do you want to do for the patient? What test do you want to do or drug do you want to provide? What factors or exposures may affect the patient? Is the intervention a procedure, drug, test, questionnaire, time?


    Compare or Control of interest, alternative approaches to the problem or issue
What is the control or alternative management strategy? Are you looking at two different tests? A drug and a placebo? Intervention versus no intervention? Your question may not always have a specific comparison.


   Outcome, what is trying to be achieved
The patient-relevant consequences of the intervention. What you hope to achieve or accomplish or learn. For example, do you want to improve function, test scores? Patient-oriented outcomes. 


    Time/Type of Question, Type of Study
What time periods should be considered? What is the study design/type used to answer the question? What types of questions are trying to be answered? Try to identify the question scenario. Is it a prospective study, double-blind, or other? What is the clinical area that your question aligns with?


Consider the type of question you are asking and the types of studies that could best answer it. When you have a well-focused question it is easier to determine the appropriate type of evidence needed. 

For Example

In child patients with knee replacements (Population), how effective is pain medication (Intervention) compared to aerobic stretching (Comparison) in controlling post operative pain (Outcome) during the perioperative and recovery time (Time)?


Remember, evidence-based medicine always begins and ends with the patient, what can you do to support or help your patient?


PICO Question Examples

It can be helpful to classify your question based on the clinical domain(s) it falls under.  


Questions addressing the treatment of an illness or disability.

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

In African American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)? (Time is optional).


Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

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

Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Time is implied in two weeks and 24 hours old.

In middle-aged men with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared with one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?


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 for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)?

Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?

Are 30- to 50- year old women (P) who have high blood pressure (I) compared with those without high blood pressure (C)at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?


Questions on how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.

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

In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?


Questions addressing the prediction of the course of a disease.

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?
In _______ (P), how does ________ (I) compared to ________ (C) influence _________ (O) over _________ (T)?

Does telemonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?

For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

Quality of Life/Meaning

Questions addressing how one experiences a phenomenon.

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

How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?

How do 20 something men (P) with a diagnosis


Questions around how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.

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

What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?

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Template for asking PICOT questions


In ____________________ (P), how does ____________________ (I) compared to ____________________ (C) affect _____________________ (O) within ___________ (T)?


In __________________(P), how do best practices or strategies (I) compared to current practice (C) affect _______________(O) within ___________(T)?         


How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________ (T)?


In ______________ (P), how does ___________________ (I) compared to _____________ (C) influence __________________ (O) over _______________ (T)?


In ___________________ (P) are/is ____________________ (I) compared with _______________________ (C) more accurate in diagnosing _________________ (O)?


Are____________________ (P), who have ____________________ (I) compared with those without ___________________ (C) at ____________ risk for/of ____________________ (O) over ________________ (T)?

Short definitions of different types of questions

Intervention/Therapy: When you need to know what is the best approach to this situation?

Issue: When you need to know what is the best approach to a situation?

Meaning: When you need to know about the experience of this situation.

Prognosis/Prediction: Do you need to know what is the most likely progression for a patient? 

Diagnosis: When you need to know about tests related to a patient’s diagnosis.

Etiology: When you need to know about risk factors contributing to a patient’s diagnosis. 

PICO Question Notes

  • Searchable questions produce your key words to use searching the literature!
  • Searchable questions are NOT your PROJECT!
  • Searchable questions are specific and not biased.
  • PICO questions are always written in the past tense.
  • Use terms that will be in the literature (no “local” terms)
  • Do not use a direction (improve, decrease) in PICOT questions.
  • Population and outcome must match – the outcome must address the population.

Sample questions


  1. In patients with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)? 
  2. In children with spastic cerebral palsy (P), how does splinting and casting (I) compared to constraint- induced therapy (C) affect two-handed skill development (O)?


In healthcare organization*, how do best practices or strategies compared to current practice affect retention?


How do children (P) with asthma (I) perceive participation in school sports and activities (O)?


In patients 65 years and older (P), how does the influenza vaccine (I) compared to no influenza vaccine (C) influence development of pneumonia (O) during flu season (T)?


In adult patients with acute abdominal pain (P), is IV and oral contrast (I) compared with IV only contrast (C) more accurate in diagnosing appendicitis (O)?


Are adopted children (P) who have parents with elevated BMI (I) compared with those parents with normal BMI (C) at risk for obesity (O)?

Adapted from Melnyk & Fineout-Overholt, 2019. This template may be used for educational & research purposes without permission.

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