Clinical examples using PICO

Clinical example

George wants to discuss the possibility of a vasectomy. He says he has heard something about vasectomy causing an increase in testicular cancer later in life. You know that the risk of this is low but want to give him a more precise answer.

Using the PICO method for constructing a clinical question, we will structure a question to explore the evidence. When you are ready click to see the suggested answers.

Question component	Suggested answer
Population	Adult males
Intervention	Vasectomy
Comparison	None
Outcomes	Testicular cancer

These elements, brought together as a focused question, might look like this:

Question	In men, does having a vasectomy increase the risk of getting testicular cancer in the future?

Try a clinical example for yourself:

Jenni comes to your antenatal clinic. She would like to consider a waterbirth, but wants to know if being born underwater, compared with being born on ‘dry land’, would present any additional risks to her baby.

Question: Using the PICO method for constructing a clinical question, think about how you would structure a question in this situation. When you are ready click on the Answer icon(s) to see the suggested answers.

Population	Newborn babies
Intervention	Waterbirth
Comparison	'Land' birth
Outcomes	Neonatal morbidity or mortality

What might your question look like?

Question	In newborn babies, does a waterbirth (compared with being born ‘on dry land’), increase the risk of morbidity or mortality?

More PICO examples from clinical practice

Further examples of focused clinical questions based on the PICO method. We will use these examples as we progress through the sections of this module

Questions are commonly either concerned with the efficacy of an intervention (such as drug treatments, clinical therapies, or lifestyle changes), diagnosis (concerning the ability of a test to accurately diagnose), or a prognosis (concerned with likelihood or risk).

Clinical example

A GP with a special interest in smoking cessation wants to encourage those in her practice to engage with teenagers to stop them smoking. In order to persuade her colleagues she wants to see what evidence is available, particularly on the effectiveness of brief intervention techniques.

Population	Teenagers who smoke
Intervention	Brief intervention
Comparison	None
Outcomes	Smoking cessation

Brought together as a focused question, it might look like this:

Question	Can brief intervention be used as an effective smoking cessation technique with teenagers?

Clinical example - Diagnosis question:

Patients presenting to their GP with a sore throat should not automatically be prescribed antibiotics as many sore throats are non-bacterial in origin. The gold standard for diagnosing bacterial sore throat is a throat swab and culture but this is expensive and time-consuming. GPs need a quick, easy diagnostic tool (e.g. a checklist or scorecard) to help them to decide whether a sore throat is bacterial or non-bacterial in origin.

Population	Patients with sore throat
Intervention	Checklist or scorecard
Comparison	Throat swab (gold standard diagnostic test for sore throat)
Outcomes	Accurate diagnosis

Your question in this case might look like this:

Question	Does a sore throat checklist or scorecard help GPs differentiate between bacterial (requiring antibiotics) and non-bacterial infection in patients presenting with a sore throat?

Clinical example - Intervention question:

A doctor contacts the pharmacy department. She is considering whether to give her patient with chronic renal failure a regimen of acetylcysteine prior to use of contrast dye for imaging to prevent renal toxicity. She mentions that this is in addition to just adequate hydration.

Try structuring this question:

Population	Patients with chronic renal failure
Intervention	Regimen of acetylcysteine
Comparison	Adequate hydration
Outcomes	Renal protection

Your question might look like this:

Question	In patients with chronic renal failure requiring use of contrast for imaging, does the administration of acetylcysteine compared to just adequate hydration, produce renal protection?

Clinical example - Prognosis (likelihood) question:

Many prognosis questions only require a population (P) and an outcome (O) because they often relate to broad populations rather than comparing subgroups.

The parents of an adolescent with schizophrenia are concerned about their son’s future health. They ask you about the likelihood of relapse.

Try structuring this question.

Population	Adolescents with schizophrenia
Outcome	Relapse

Your question might look like this:

Question	For adolescents with schizophrenia, what is the likelihood of relapse?