The PICO process (or framework) is a
mnemonic
A mnemonic device ( ), memory trick or memory device is any learning technique that aids information retention or retrieval in the human memory, often by associating the information with something that is easier to remember.
It makes use of e ...
used in
evidence-based practice (and specifically
evidence-based medicine
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available exte ...
) to frame and answer a clinical or health care related question,
though it is also argued that PICO "can be used universally for every scientific endeavour in any discipline with all study designs".
The PICO framework is also used to develop literature search strategies, for instance in
systematic reviews.
The PICO acronym has come to stand for:
* PPatient, problem, or population
* IIntervention
* CComparison, control, or comparator
* OOutcome(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:
* PPatient, problem, or population
* IInvestigated condition (e.g. intervention, exposure, risk/ prognostic factor, or test result)
* CComparison condition (e.g. intervention, exposure, risk/ prognostic factor, or test result respectively)
* OOutcome(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
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...
,
cohort study
A cohort study is a particular form of longitudinal study that samples a Cohort (statistics), cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or gra ...
, etc.)
PICO as a universal technique
It was argued that PICO may be useful for every scientific endeavor even beyond clinical settings.
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
The null hypothesis (often denoted ''H''0) is the claim in scientific research that the effect being studied does not exist. The null hypothesis can also be described as the hypothesis in which no relationship exists between two sets of data o ...
); 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
A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...
, is
paracetamol
Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely available over-the-counter drug sold under various brand names, including Tylenol and Panadol.
Parac ...
more effective than
placebo
A placebo ( ) can be roughly defined as a sham medical treatment. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures.
Placebos are used in randomized clinical trials ...
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
PubMed is an openly accessible, free database which includes primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institute ...
(health research database) search strateg
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?"
* 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)
Similar Frameworks
The PICO framework was originally developed to frame interventional clinical questions. PICO inspired other frameworks such as PICOS, PICOT, PICOTT, PECO, PICOTS, PECODR, PEICOIS, PICOC, SPICE, PIPOH, EPICOT+, PESICO, PICo, and PS.
References
Evidence-based practices
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