PICO process
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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
[edit]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.
| PICO component | Abstract component inherent to all research designs |
|---|---|
| Problem | Research object |
| Intervention | Application of a theory or method |
| Comparison | Alternative theories or methods (or, in their absence, the null hypothesis) |
| Outcome | Knowledge generation |
This proposition would imply that the PICO technique could be used for teaching academic writing even beyond medical disciplines.
Examples
[edit]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)
Similar Frameworks
[edit]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.[9]
References
[edit]- ^ Huang X, Lin J, Demner-Fushman D (2006). "Evaluation of PICO as a knowledge representation for clinical questions" (PDF). AMIA Annu Symp Proc. 2006: 359–63. PMC 1839740. PMID 17238363.
- ^ a b Nishikawa-Pacher, Andreas (2022). "Research Questions with PICO: A Universal Mnemonic". Publications. 10 (3): 21. doi:10.3390/publications10030021. eISSN 2304-6775.
- ^ 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.
- ^ "Asking a Good Question (PICO)". 17 November 2004. Archived from the original on 2011-02-26. Retrieved 2010-05-18.
- ^ Richardson, WS (1995). "The well-built clinical question: a key to evidence based-decisions". ACP Journal Club. 123, 3 (3): A12–A13. doi:10.7326/ACPJC-1995-123-3-A12.
- ^ "Systematic Review Methods". Chapter 2. Systematic Review Methods -- AHRQ Technical Reviews and Summaries -- NCBI Bookshelf. Agency for Healthcare Research and Quality (US). March 2009. Retrieved 2010-05-18.
- ^ Richardson, WS (1995). "The well-built clinical question: a key to evidence based-decisions". ACP Journal Club. 123, 3 (3): A12–A13. doi:10.7326/ACPJC-1995-123-3-A12.
- ^ a b Luijendijk HJ (2021). "How to PICO questions about medical tests". BMJ Evidence-Based Medicine. 26 (4): 155–157. doi:10.1136/bmjebm-2021-111676. PMC 8311106. PMID 33789913.
- ^ Shokraneh, Farhad (2019). "PICO Framework: Two Decades of Variation and Application". F1000Research. 8: 1419. doi:10.7490/f1000research.1117334.1.
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