PICO process

The PICO process (or framework) is a mnemonic used in evidence-based practice (and specifically evidence-based medicine) to frame and answer a clinical or health care related question.[1] The PICO framework is also used to develop literature search strategies, for instance in systematic reviews.[2] The PICO acronym has come to stand for:[3][4]

  • P – Patient, problem or population
  • I – Intervention
  • C – Comparison, control or comparator[5]
  • O – Outcome(s) (e.g. pain, fatigue, nausea, infections, death)
This article is about the medical technique. For pico processes in Microsoft Windows, see Windows Subsystem for Linux § Development.
For other uses, see Pico.

An application that covers clinical questions about interventions, as well as exposures, risk/ prognostic factors, and test accuracy, is:[6][7]

  • P – Patient, problem or population
  • I – Investigated condition (e.g. intervention, exposure, risk/ prognostic factor, or test result)
  • C – Comparison condition (e.g. intervention, exposure, risk/ prognostic factor, or test result respectively)
  • O – Outcome(s) (e.g. symptom, syndrome, or disease of interest)

Alternatives such as SPICE and PECO (among many others) can also be used. Some authors suggest adding T and S, as follows:

Examples

Clinical question: "In children with headache, is paracetamol more effective than placebo against pain?"

  • Population = Children with headaches; keywords = children + headache
  • Intervention = Paracetamol; keyword = paracetamol
  • Compared with = Placebo; keyword = placebo
  • Outcome of interest = Pain; keyword = pain

Pubmed (health research database) search strategy:children headache paracetamol placebo pain

Clinical question: "Is the risk of having breast cancer higher in symptom-free women with a positive mammography compared to symptom-free women with a negative mammography?"[7]

  • Population = Women without a history of breast cancer
  • Investigated test result = Positive result on mammography
  • Comparator test result = Negative result on mammography
  • Outcome of interest = Breast cancer according to biopsy (or not)

References
  1. Huang X, Lin J, Demner-Fushman D (2006). "Evaluation of PICO as a knowledge representation for clinical questions" (PDF). AMIA Annu Symp Proc: 359–63. PMC 1839740. PMID 17238363.
  2. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P (2007). "Utilization of the PICO framework to improve searching PubMed for clinical questions". BMC Med Inform Decis Mak. 7: 16. doi:10.1186/1472-6947-7-16. PMC 1904193. PMID 17573961.
  3. "Asking a Good Question (PICO)". 17 November 2004. Archived from the original on 2011-02-26. Retrieved 2010-05-18.
  4. Richardson, WS (1995). "The well-built clinical question: a key to evidence based-decisions". ACP Journal Club. 123, 3: A12–A13.
  5. "Chapter 2. Systematic Review Methods -- AHRQ Technical Reviews and Summaries -- NCBI Bookshelf". Retrieved 2010-05-18.
  6. Richardson, WS (1995). "The well-built clinical question: a key to evidence based-decisions". ACP Journal Club. 123, 3: A12–A13.
  7. Luijendijk HJ (2021). "How to PICO questions about medical tests". BMJ Evidence-Based Medicine. doi:10.1136/bmjebm-2021-111676. PMC 8311106. PMID 33789913. Retrieved 2021-04-29.{{cite journal}}: CS1 maint: url-status (link)
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