Avera Nursing & Pharmacy Staff: PICO Development

P - Patient, Problem Population

In addition to being at risk for a health problem, the patient is a member of a population. Therefore, age, sex, ethnicity, socioeconomic status and other demographic variables may need to be taken into consideration when structuring the search and considering the retrieved evidence. 

Ask yourself:

• How would you describe a group with a similar problem?
• How would you describe the patient to a colleague?
• What are important characteristics of this patient?
• What is the primary problem, main concern, or the patient's chief complaint?
• Think about the patient's age, race, sex, previous ailments, or current medications and whether these characteristics should be considered as you search for evidence.

I - Intervention

The intervention is the main consideration for that patient or client. In the intervention part of the PICO, it is important to identify what you plan to do for that patient. Your intervention should not be “best practices.” Not only is "best practices" not searchable, but it is too broad of an idea. You want to use specifics in your intervention.

Interventions may include:

• Specific diagnostic test
• Treatment
• Adjunctive Therapy
• Medication
• Product
• Procedure

C - Comparison, Control

The comparison is the main alternative you are considering. It should be specific and limited to one alternative choice to facilitate an effective computerized search. The comparison is an optional component in the PICO framework. You can look at the intervention without having an alternative. Also, it is not always possible to define a comparison or control for the PICO.

O - Outcomes

The outcome specifies the result(s) of what you plan to accomplish, improve or affect and must be measurable and, ideally, should measure quality of life and clinical well-being, not just laboratory test results. 

Outcomes may consist of:

• Relieving or eliminating specific symptoms
• Improving or maintaining function
• enhancing esthetics

Specific outcomes will yield better search results and allow you to find the studies that focus on the outcomes you are searching for. When defining the outcome, "more effective" is not acceptable unless it describes how the intervention is more effective (e.g., more effective in preventing pressure ulcers or in decreasing pain).

It is not usually advisable to use the ‘Outcomes’ element of PICO in a search strategy. This is because it can reduce the recall of the search, which risks excluding potentially relevant studies (e.g., those that measured the outcome of interest but did not report it in the published paper). It also introduces bias in the results.