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] though it is also argued that PICO "can be used universally for every scientific endeavour in any discipline with all study designs".^[2] The PICO framework is also used to develop literature search strategies, for instance in systematic reviews.^[3]

The PICO acronym has come to stand for:^[4][5]

• P – Patient, problem or population
• I – Intervention
• C – Comparison, control or comparator^[6]
• O – Outcome(s) (e.g. pain, fatigue, nausea, infections, death)

An application that covers clinical questions about interventions, as well as exposures, risk/ prognostic factors, and test accuracy, is:^[7][8]

• 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:

• T - Timing (e.g. duration of intervention, or date of publication)
• S - Study type (e.g. randomized controlled trial, cohort study, etc.)

PICO as a universal technique

It was argued that PICO may be useful for every scientific endeavor even beyond clinical settings.^[2] This proposal is based on a more abstract view of the PICO mnemonic, equating them with four components that is inherent to every single research, namely (1) research object; (2) application of a theory or method; (3) alternative theories or methods (or the null hypothesis); and (4) the ultimate goal of knowledge generation.

This proposition would imply that the PICO technique could be used for teaching academic writing even beyond medical disciplines.

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?"^[8]

• 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

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