Developing a Clinical Question with PICO or PICOT
Start with a Plan
Beginning a literature search can sometimes feel overwhelming. One of the best things you can do to build an effective search is to spend some time developing a clear and concise research question. This practice will help you focus on the most important parts of your question and to provide the database with search terms it can understand.
Depending on a researcher's goals, there are several models or frameworks available to help in structuring a research question. There are at least 25 of these different tools, which are typically expressed in mnemonics. Not any one is superior to another or mandatory to use. It is all dependent on the nature of the research question, if qualitative or quantitative data is needed, and what works best for a project as a whole.
Developing a Clinical Question with PICO or PICOT
When looking at topics that surround clinical interventions, PICO is a mnemonic that helps organize a case scenario or research topic into a focused clinical research question. PICO stands for: Population, Intervention, Comparison, and Outcome. PICOT incorporates all the information previously mentioned but also includes the aspect of time.
Image Caption:
Images depict the elements of the PICO and PICOT frameworks. A text version of this information is also available: PICO & PICOT
Helpful Tools
- Video Tutorial on PICO FrameworkWith this tutorial, you’ll learn the four elements of the PICO model and how to use PICO to refine your research question.
- Literature Searching WorksheetHelpful tool for PICO(T) development.
Further Reading
Literature Reviews for Education and Nursing Graduate Students by
Literature Reviews for Education and Nursing Graduate Students is an open textbook designed for students in graduate-level nursing and education programs. Its intent is to recognize the significant role the literature review plays in the research process and to prepare students for the work that goes into writing one. Developed for new graduate students and novice researchers just entering into the work of a chosen discipline, each of the eight chapters covers a component of the literature review process. Students will learn how to form a research question, search existing literature, synthesize results and write the review. The book contains examples, checklists, supplementary materials, and additional resources. Literature Reviews for Education and Nursing Graduate Students is written by two librarians with expertise guiding students through research and writing assignments, and is openly licensed.
Publication Date: 2017
Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition by
The dynamic and competitive US healthcare environment requires healthcare professionals who are accountable to provide efficient and effective care. New evidence is continually surfacing in nursing and medical environments. Consumer pressure and increased patient expectations place an even greater emphasis on the need for healthcare professionals to deliver true evidence-based care in their daily practice. Johns Hopkins Nursing is steadfastly dedicated to making it easy for frontline nurses, health professionals, and students to use best evidence in their everyday practice. With each edition, we revise based on the honest, frank, and generous feedback we receive from frontline users of the Johns Hopkins Evidence-Based Practice Model from across the globe. In this fourth edition, we are excited to be able to share these changes. The 2021 revised JHEBP Model underscores the need for organizations to cultivate both a spirit of inquiry and an environment of learning that encourages questioning and seeking best evidence and its implementation and adoption in practice. Although our model was developed, tested, and implemented by and for nurses, we have had numerous requests and feedback from other health professionals to use the Hopkins model. Thus, we introduce the fourth edition with a new title-Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals. This change reflects the growing evidence base of the importance for interprofessional collaboration and teamwork, particularly when addressing complex care issues such as those often tackled by EBP teams. In this edition, our overarching aim is to provide practical and pragmatic explanations, approaches, and tools to guide and support teams engaging in EBP projects: We explicitly reflected the interprofessional nature of the EBP process and its use by all disciplines who serve, interact with, and care for those who seek services.We revised the flow of the book chapters across the sections to reflect the progression of steps in the EBP process.We included a new introduction for the evidence section that includes background on the use of evidence hierarchies, tips for differentiating research from quality improvement, and further explanation of the summary and synthesis steps in the evidence process.We made significant enhancements to the appendices by including flowcharts, decision supports, and greater specificity in the directions.We provided real-world examples for how to complete all tools using feedback from our global users as well as tried and tested helpful hints.We added a new chapter to expand and amplify strategies for dissemination that includes how to create a dissemination plan, audience-specific recommendations for internal and external dissemination venues, details of the pros and cons of different types of dissemination, guidance on submitting manuscripts for publication, and an overview of the journal review process.Chapter-specific enhancements: Chapter 3: Defines critical thinking and clinical reasoning and differentiates their use in the PET process.Chapter 4: Outlines stakeholder selection criteria and an algorithm to determine the need for an EBP project.Chapter 5: Includes new information on the literature screening process to navigate a large number of results Chapter 6: Provides useful clarifications of research approaches, designs, and methods with a focus on frontline staff as the target audienceChapter 8: Includes revised synthesis and translation steps; assesses risk prior to translation; prioritizes translation models accessible to frontline staff with a focus on the QI methodology and PDSA; and describes an expanded list of outcome measures to determine the success of an EPB project.
ISBN: 1948057875Publication Date: 2021-07-15
Developing a Non-Clinical Question
Not every question will be clinical in nature. Some questions focus on patient or provider experiences, exploring phenomenon, or exposures.
PICo
Often articulated as PIC-little o, PICo allows for a researcher to be as broad or specific as necessary. It examines a particular population or problem, interest within the population or problem, and the context surrounding the population or problem.
PEO
The PEO question framework is used to evaluate the association between a particular exposure or risk factor and the outcome. It examines a particular population, exposure within the population, and the outcome being examined.
SPICE
The SPICE question framework is used to evaluate the outcomes of an intervention, service, or project. It examines a particular setting, perspective, intervention / exposure / interest, comparison, and evaluation.
SPIDER
The SPIDER question framework is used to evaluate samples rather than populations. It examines a particular sample, phenomenon of interest, design, evaluation, and research type.
Image Caption:
Images depict the elements of the PICo, PEO, SPICE, and SPIDER frameworks. A text version of this information is also available: Non-Clinical Frameworks