Student Resources

After first identifying an information need, the next step in evidence-based practice is to re-frame the problem by posing a clearly stated and searchable question. EBP practitioners use a structure called PICO to advance their thoughts from fuzzy and generalized to crisp and precise. 

PICO is a framework for structuring a clinical question by separating it into four components. Framing the PICO helps you identify some of the keywords you will use in searching databases. 

P = What are the significant characteristics of the patient or the population?

I = What intervention are you considering?

C = Are you considering another intervention as a comparison to the first?

O = What is the desired outcome of the intervention(s)?

Time is sometimes a fifth element of PICO.

(T) = How much time does it take for an intervention to reach an outcome?

These resources further define PICO and describe how to formulate good research questions around the framework of Patient, Intervention, Comparison, and Outcomes.

A PICO worksheet helps you organize your search strategy. Use a worksheet to:

• Structure your question using the PICO elements.
• Jot down terms that describe each element of the question, i.e. plain language terms, alternate terms (synonyms), and subject headings. These are terms you plan to search for when you use the database(s).
• Identify the type of clinical question you are trying to answer, e.g. therapy, prevention, etc.
• Denote the type(s) of research studies you are going to try to find, e.g. systematic review, RCT, etc.
• Denote inclusion/exclusion criteria specific to your search, e.g. male or female, age range, etc.
• List the databases you intend to search, e.g. PubMed, CINAHL, Cochrane, etc.

Start your search broadly, beginning with only the P and the I elements. Do not include the O element in your initial search unless you must, ie. if the number of results from the P and I search is too huge to peruse. Why? Outcomes can be described in very specific terms. If you do not happen to choose the exact words that a researcher/author happened to use, you just might eliminate a valuable study. 

Scope out the databases you plan to use. Find a few relevant studies and examine the complete references to identify two items:

1. Subject headings the database indexers used to describe the studies 
2. Keywords in the articles' abstracts.

Add the relevant terms to your PICO worksheet.

Search for one term at a time. After you have searched for each P element, connect those related terms with the Boolean "OR." Repeat for the I element.

To link the P and I elements of your question, combine the complete P results set and the complete I results set with the Boolean "AND."

Limit the results by study design, working your way down the evidence pyramid.

If need be, search for your question's O element and link it with the P and I elements.