Clinical Resources

Evidence Based Practice

PICO(TT): Definitions and Examples

PICO(TT) Model & Question Types

This model helps us create searchable clinical questions before we start looking at the literature. 

P - Population 

I - Intervention

C - Comparison or Control

O - Outcome (desired or of interest)

 T- Time period

T - Type of Question (Is this a diagnosis, therapy, prognosis, etiology/harm, or prevention question?)

T -Type of Study Design (What study design would best answer this question? RCT, Cohort, Case Series, etc.

Question: In POPULATION, does INTERVENTION as compared to COMPARISON/CONTROL GROUP result in OUTCOME?

Keep in mind, you may not have all the pieces depending on your type of question, but it's a great jumping off point.

 

Example 1 - Therapy

Scenario: You have a female patient who has recently been diagnosed with SLE. Her rheumatologist suggested she start on Plaquenil for her joint pain, but she is interested in alternative therapies because she heard about success a neighbor had with turmeric tea.

P- patients with SLE

I- turmeric tea

C- Plaquenil (standard drug therapy)

O- reduction of joint pain

Question: In adult patients with SLE, is consuming turmeric tea more effective than Plaquenil at reducing joint pain?

This question could be more specific (Gender specific? What counts as a reduction in joint pain?), but is still a therapy question. We're comparing an alternative therapy (turmeric tea) with a more standard drug therapy (Plaquenil). 

Example 2 - Diagnosis/Diagnostic Test

Scenario: Your patient has a history of blood clots and after they came in to your clinic with right calf discomfort and tightness, you're concerned about DVT. You remember reading about the limitations of duplex ultrasound and calfveins, and are wondering if a d-dimer assay can help you rule out DVT more accurately. 

P- adults

I- d-dimer assay

C- ultrasound

O- more accurate diagnosis of DVT

Question: Is ddimer assay more accurate at ruling out deep vein thrombosis compared to ultrasound?

Example 3 - Etiology

Scenario: Your female patient is concerned about her risk of developing breast cancer. Her friend was recently diagnosed, and mentioned that her smoking might have been a factor. Your patient and her wife have lived together for 10 years, and while she doesn't smoke, her partner does. Is she at an increased risk over someone without daily exposure to second-hand smoke?

P- female non smokers w/ daily second hand smoke exposure

I-

C- female non smokers w/o daily smoke exposure

O- develop breast cancer

T-  over ten years

Question: Are female non-smokers with daily exposure to second-hand smoke over a period of ten years or greater more likely to develop breast cancer when compared with female non-smokers without daily exposure to second hand smoke?

Example 4 - Prognosis

Scenario: Your patient, who owns a bakery, recently participated in their employer's wellness program. Their BMI is within a normal range, but they have a family history of obesity, and are concerned about the impact carbs may have on maintaining a healthy weight.

P- pts w/ family history of obesity

I- carb intake; specific diet? 

C-

O- keeping BMI below 25; healthy weight management

Question: Does dietary carbohydrate intake influence healthy weight maintenance (BMI <25) in patients who have family history of obesity (BMI >30)?

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