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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?

PICO Examples

Element of the clinical question


 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?
Including an exposure to disease, a diagnostic test, a prognostic factor, a treatment, a patient perception, a risk factor, etc.

Comparison (optional)

  Is there an alternative treatment to compare?
Including no disease, placebo, a different prognostic factor, absence of risk factor, etc.


  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.

Asking Different Types of Questions

 Fill in the blanks with information from your clinical scenario:

In_______________, what is the effect of ________________on _______________ compared with _________________?

For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

Does ____________ influence ______________ in patients who have _____________?

Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________


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.

More on PICO & Clinical questions

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


CPR  -  cardiopulmonary resuscitation

I - Hands-only

 hands-only OR compression-only OR chest compression OR compression OR Heart Massage


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.