1 Define the Problem and Develop a Protocol

Common tool PICO

The aim of PICO is to translate the guideline topic into a series of structured and searchable key clinical questions as a bias for performing the literature search.

PICO is an acronym for:

P Patient population or clinical problem

Ø characteristics of the patient or population

Ø condition or disease of interest

I Intervention (therapy or diagnostic test under investigation; presence of etiological or prognostic factor)

C Comparison (alternative therapy; index or reference test; absence of etiological or prognostic factor)

O Outcome measures

The PICO method:

The circles with the letters P, I C and O should be seen as the collection of searched literature. By combining these collections, the correct literature (shaded area in the figure) can be extracted. Combinations can be made with Boolean’s.

(source: CBO evidence based guideline development protocol)

PICO Worksheet

1. Define your question using PICO

· Population:

· Intervention:

· Comparison:

· Outcome:

2. Write out your question

Examples

Prognostic question

1. PICO

· Population: patients with cervical cancer

· Intervention: presence histological parameters

· Comparison: absence of histological parameters

· Outcome: survival

2. Question:

In patients with cervical cancer, does presence of histological parameter ABC as compared to absence of histological parameter ABC, result in improved survival?

Diagnostic question

1. PICO

· Population: patients with cervical cancer

· Intervention: MRI

· Comparison: CT

· Outcome: detecting relapsed or recurrent disease

2. Question:

In patients with cervical cancer, will MRI as compared to CT result in increased detection of relapsed or recurrent disease ?

Therapeutic question

1. PICO

· Population: patients with rectal cancer

· Intervention: abdominoperineal resection

· Comparison: low anterior resection

· Outcome: mortality and quality of life

2. Question:

For patients with with rectal cancer,stage XYZ, will abdominoperineal resection as compared to low anterior resection result in decreased mortality and improved quality of life of treating a patient?

Validated