PICO is a mnemonic that helps one remember the key components of a well focused question. The question needs to identify the key problem of the patient, what treatment you are considering for the patient, what alternative treatment is being considered (if any) and what is the outcome you want to avoid or promote.
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.
Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient? Age? Co-existing problems? Has the patient been exposed to something? Asbestos? Cigarette smoke?
What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question does not always need a specific comparison.
What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores?
Example PICO Statements from CINAHL Evidence based practice care sheets:
1. In the elderly at risk of falling, is tai chi effective in reducing the risk and preventing falls as compared with those who do not practice tai chi?
2. Are alcohol based hand rubs more effective or less effective in reducing HRI's than soap and water techniques?
3. Is peer-pressure more effective than educational interventions in improving hand hygiene practices?
4. Are PPI's (proton pump inhibitors) effective medical therapy for esophagitis and GERD in children and adolescents?
5. In older adults with wandering, is music therapy or exercise/activities more effective in decreasing wandering/pacing?