Step 1 - Ask A Clinical Question

What is PICO(T)?

Posing a clinical question using the PICO(T) framework allows the researcher to create a structured, focused question which drives the subsequent steps of the evidence-based process. Developing a PICO(T) question may be seen as the most challenging step of the evidence-based process, however, once it is determined, it aids the researcher in finding the best evidence available related to the issue being addressed. The following table defines and provides an example of a research question structured using PICO(T) components.

Patient/Population​

The patient population or disease of interest. 
 
Considerations:
  • How is the disease/condition defined?
  • What are the most important characteristics that describe the population?
  • Are there any relevant demographic factors (e.g. age, sex, ethnicity)?
  • What is the setting (e.g. hospital, community etc)?
  • Are there other types of patient who should be excluded from the review (because they are likely to react to the intervention in a different way)?

Example: pediatric patient

Intervention​

The intervention or range of interventions of interest.

Considerations:

  • What is the experimental intervention of interest (e.g. exposure to disease, prognostic factor A, and risk behavior)?
  • Does the intervention have variations (e.g. dosage/intensity, mode of delivery, personnel who deliver it, frequency of delivery, duration of delivery, and timing of delivery)?
  • Are all variations to be included (for example is there a critical dose below which the intervention may not be clinically appropriate)?
  • How will trials including only part of the intervention be handled?
  • How will trials including the intervention of interest combined with another intervention be handled?
Example: effect of dexamethasone

Comparison​

What the intervention should be compared against.

Considerations:
  • What is the comparison of interest (e.g. no disease, placebo, no intervention/therapy, prognostic factor B, and absence of risk factor)?
  • Does the comparison have variations (e.g. dosage/intensity, mode of delivery, personnel who deliver it, frequency of delivery, duration of delivery, and timing of delivery)?
  • Are all variations to be included (for example is there a critical dose below which the comparison may not be clinically appropriate)?
  • How will trials including only part of the comparison be handled?
  • How will trials including the comparison of interest combined with another intervention be handled?
Example: effect of ondansetron

Outcome​

Outcome of interest.
Considerations:
  • Ensure that outcomes cover potential as well as actual adverse effects.
  • Main outcomes are those that are essential for decision-making, and should usually have an emphasis on patient-important outcomes.
  • Primary outcomes are the two or three outcomes from among the main outcomes that the review would be likely to be able to address if sufficient studies are identified, in order to reach a conclusion about the effects (beneficial and adverse) of the intervention(s).
  • Secondary outcomes include the remaining main outcomes (other than primary outcomes) plus additional outcomes useful for explaining effects.
  • Consider outcomes relevant to all potential decision makers, including economic data.
Example: preventing nausea

Time​

Timeframe of outcome measure.
Considerations:
  • Timeframe is optional in the PICO(T) framework.
  • Specifying a timeframe may not always be applicable to the study question.
Example: one week