Term 2: PICOT Model for Asking Clinical Questions
The PICOT model helps you to develop a specific clinical research question. With this focus, when you search you'll find targeted results and not waste time on irrelevant material.
P, I, and O components must be present.
C and T may or may not be present, depending on the question.
- Patient population
Describe a group of patients similar to yours. Use factors such as: age group, gender, ethnicity, having a disease or condition.
Example: overweight adult with hypertension
- Intervention or issue of interest
Describe the intervention you are considering, such as a treatment or diagnostic test.
Example: diet and lifestyle changes
If appropriate, identify the main alternative treatment for comparison.
Example: no change in diet or exercise
Describe the desired effect or outcome for the patient.
Example: weight loss and reduction in blood pressure
The outcome MUST be measureable. For example, "feeling better" would not be a measurable outcome.
If a specific time period is relevant for your question, note the period over which population is observed or outcome is measured. Note that many PICO questions do not include time.
Example: within three months
Resulting PICOT question:
In overweight adults with hypertention, does changing diet and exercise result in weight loss and reduced blood pressure within a three month time period?
See this example demonstrated:
Evidence-Based Practice: What it is and What it is Not
- streaming video, 20 min
- a student develops this PICO question based on her clinical experience
- PICO discussion starts at 8:22 min
“… a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.” (Stillwell et. al., 2010)
As evidence based practice evolved in health professions (including nursing) in the late 1990s and early 2000s, PICO (and later PICOT) was developed as the standard way to ask structured, focused, answerable clinical questions. Key words and concepts from the PICOT question could then be used to search nursing and biomedical literature for the best current evidence.
In 7 steps, here's how to work PICOT into the EBP research process:
Use the PICOT worksheet to sketch out:
- P-I-C-O-T elements for your topic
- some are optional, and some you may not know yet
- Question type
- is it an intervention, etiology, diagnosis, prognosis, or meaning question?
- How you might state your PICOT question
- scanning question templates/examples can help you to frame your question
At this point, you still may not know:
- if there is enough evidence to answer your clinical question
- what specific, measurable outcome is the best one to use
- whether you need to narrow or broaden your population any further
- whether you should modify/change your intervention or comparison
The next step is to search Medline and/or CINAHL to answer those questions, so you can develop an answerable PICOT question.
Some ideas for starting your search:
- List your P, I, C, O, and T terms
You may not have any C or T terms, and you might not know your O yet
- Write down a search that uses ‘AND' to combine your P and I terms
e.g. overweight adult AND lifestyle changes
- If needed, feel free to try different P and I terms
e.g. overweight adult* AND diet
adult* will search for adult, adults, adulthood, etc.
Searching in CINAHL & Medline:
- If keyword searches are not working, try to find Subject headings for your topic
- For clinical topics, limit searches to results within the last 5 years
- Plan to search both CINAHL and Medline in order to cover all possible journals of interest
Health professionals have created PICOT templates for common types of clinical questions.
- For an Intervention question:
In ______(P), how does ______(I) compared with ______(C) affect ______ (O) over ____ (T period of time)?
- For an Etiology question:
Are ______(P) who have _____(I) compared with those without ______(C) at ____ risk for ______ (O) over ____ (T period of time)?
Find more template examples:
- Templates and definintions for 5 types of PICOT questions
From: Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Asking the clinical question: a key step in evidence-based practice. Am J Nurs. 2010 March; 110(3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79
- Google PICO question template to find examples on the Web.
- Not a best/better question
- In population P, what is the best treatment for X?
- In population P, is treatment X better than treatment Y?
- Not answered by a yes/no/number
- Will population P who get treatment X see an improvement in outcome O?
- In population P, by what percentage will treatment X improve outcome O?
- Not a prediction or a thesis statement
- Population P who have intervention I compared to intervention C will have improved outcome O.
- Not an open question
- In population P, what are the barriers to outcome O?
- In population P, what is the effect of treatment X compared with treatment Y?