A qualitative PICO question focuses on in-depth perspectives and experiences. It does not try to solve a problem by analyzing numbers, but rather to enrich understanding through words. Therefore, the emphasis in qualitative PICO questions is on fully representing the information gathered, rather than primarily emphasizing ways the information can be broken down and expressed through measurable units (though measurability can also play an important role).
A strength of a qualitative PICO question is that it can investigate what patient satisfaction looks like, for example, instead of only reporting that 25% of patients who took a survey reported that they are satisfied.
When working with qualitative questions, an alternative to using PICO in searching for sources is the SPIDER search tool. SPIDER is an acronym that breaks down like this:
S=Sample
P=Phenomena of Interest
D=Design
E=Evaluation
R=Research Type
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938
Forming Focused Questions with PICO A tutorial created by University of North Carolina Chapel Hill Health Sciences Library for learning how to form questions using the PICO framework. Includes case studies and question examples.
Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice. American Journal of Nursing 2010 March; 110(3):58-61. This article provides background information on why the use of PICO question is important in Evidence Based Practice. It looks at the different types, formats, scenarios and creation of the PICO question. The article also includes a template for creating a PICO.
PICO is a mnemonic used to describe the four elements of a good clinical foreground question:
P = Population/Patient/Problem - How would I describe the problem or a group of patients similar to mine?
I = Intervention - What main intervention, prognostic factor or exposure am I considering?
C = Comparison - Is there an alternative to compare with the intervention?
O = Outcome - What do I hope to accomplish, measure, improve or affect?
Element of the clinical question |
Population/Patient/Problem Describe as accurately as possible the patient or group of patients of interest. |
Intervention (or cause, prognosis) What is the main intervention or therapy you wish to consider? |
Comparison (optional) Is there an alternative treatment to compare? |
Outcome What is the clinical outcome, including a time horizon if relevant? |
Example | In patients with acute bronchitis, | do antibiotics | none | reduce sputum production, cough or days off? |
Example | In children with cancer | what are the current treatments | in the management of fever and infection? | |
Example | Among family-members of patients undergoing diagnostic procedures | does standard care, | listening to tranquil music, or audio taped comedy routines | make a difference in the reduction of reported anxiety. |
Fill in the blanks with information from your clinical scenario:
THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?
PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?
ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________
with/without______________?
MEANING
How do _______________ diagnosed with _______________ perceive __________________?
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
We can use our PICO statement to list terms to search on. Under each letter, we'll list all the possible terms we might use in our search.
P - Community Dwelling: It is much easier to search on 'hospitalized' than non-hospitalized subjects. So I would leave these terms for last. It might turn out that I don't need to use them as my other terms from the I, C, or O of PICO might be enough.
community dwelling OR out-of-hospital
P - adults: I would use the limits in MEDLINE or CINAHL for All Adults. Could also consider the following depending upon the population you need:
adult OR adults OR aged OR elderly OR young adult
I - CPR
CPR - cardiopulmonary resuscitation
I - Hands-only
hands-only OR compression-only OR chest compression OR compression OR Heart Massage
C - CPR
CPR - cardiopulmonary resuscitation
C - Hands plus breathing Breathing is a tougher term to match.
breathing OR mouth to mouth OR conventional OR traditional
O - Mortality: If your outcomes terms are general, they may not as useful in the literature search. They will still be useful in your evaluation of the studies.
mortality OR death OR Survival
Putting it together - a search statement from the above might look like this:
cardiopulmonary resuscitation AND (hands-only OR compression-only OR chest compression OR compression OR Heart Massage) AND (breathing OR mouth to mouth OR conventional OR traditional)
Note that the above strategy is only using terms from the I and the C of PICO. Depending upon the results, you may need to narrow your search by adding in terms from the P or the O.