PICO framework - diagram

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Last Update

  • Updated.jpg 21 February 2017



See also Blogs | Evaluating health information | Evidence-based medicine | Medical education portal | Point-of-care tools in medicine | Systematic review searching

"...Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors..." ~ Cochrane Collaboration

According to Dr. David Sackett, "...evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The terms evidence-based health care and evidence-based practice are used as synonyms for evidence-based medicine. In order to help frame the clinical question in evidence-based medicine, PICO is used to assist clinicians and librarians particularly for developing and determining a logical order for search terms. In some cases, the biomedical literature will not produce sufficient evidence that capture complexities of specific patients. All of the evidence must be placed in context, at the bedside or in clinic, with a specific patient in mind. Finding the medical literature and the evidence is one part of EBM process as practitioners draw on their expertise and knowledge and apply it to patients (whose values are a critical part of the EBM process).

PICO (patient/population, intervention, comparison & outcome)

"...A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. PICO makes this process easier. It is a mnemonic for the important parts of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question...."

PICO (patient/population, intervention, comparison & outcome) is a framework used by health professionals and health librarians to frame clinical questions. As such, PICO provides help to the clinician in formulating her/his clinical question. Working through your PICO will help you and the clinician write a good clinical question, and develop a good search strategy, which aids in the retrieval of relevant clinical evidence. With PICO, there is more precise direction in searching as the first steps of evidence-based practice (EBP) are negotiated

  • The PICO framework - diagram guides searchers as it combines elements of the clinical scenario in an orderly fashion
  • The goal in PICO, of course, is to build a focused, answerable clinical question:
  • P — patient, population of patients, problem
  • I — intervention (a therapy or test)
  • C — comparison (another therapy or placebo)
  • O — outcome

Similar Frameworks

  • PICO(T)
  • WWH
  • PRoPheT


ECLIPSE was developed to address questions from the health policy and management area (Wildridge and Bell, 2002).

E Expectation: why does the user want the information?
C Client group: for whom is the service intended?
L Location: where is the service physically sited?
I Impact: what is the service change being evaluated? What would represent success? How is this measured? This component is similar to outcomes of the PICO framework
P Professionals: who provides or improves the service?
SE Service: what type of service is under consideration?


Generally speaking, health librarians use the most relevant terms, keywords and concepts from PICO to find the best evidence. Several resources are available to introduce EBM concepts and to guide you through the process of shaping your information need into a clinical question. For other examples and exercises to learn the framing of the clinical question, see:


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