Getting Started

Types of Frames

PICOTT

PICOTT is a mnemonic used to describe elements of a good clinical foreground question.

The PICOTT model is used in evidence-based practice to assist in formulation of searchable clinical questions.

How to Phrase Your PICO

PICO is a good framework to help clarify your (clinical, review, or research) question.

P - Patient, Population or Problem: What are the important characteristics of the patients &/or problem?

I - Intervention: What you plan to do for the patient or problem?

C - Comparison: What, if anything, is the alternative to the intervention?

O - Outcome: What is the outcome that you would like to measure?

Beyond PICO: the SPIDER tool for qualitative evidence synthesis.

5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting.

PICO worksheet

Education Rx
Worksheet to develop PICO question for clinical rounds.

Other Mnemonics

Search Concept Tools : PICO and other tools for developing research questions and search concepts

A variety of tools are listed that can be used to formulate your research question and identify possible search concepts for your literature search. As a rule of thumb pick the 2-4 concepts which are most simple to search for.*

1. CLIP –Health service management questions

C Client – at whom is the service aimed?

L Location – where is the service sited?

I Improvement – what do you want to find out?

P Professional – who is involved in providing/improving the service?

2. CMO or CIMO - Realist Synthesis questions

C Context

I Intervention

M Mechanism

O Outcome

Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. BMC medicine. 2013 Jan 29;11(1):21.

3. ECLIPS(E) – Health service management questions

E Expectation—what does the search requester want the information for (the original ‘I’s)?

C Client Group.

L Location.

I Impact—what is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured?

P Professionals.

S Service—for which service are you looking for information? For example, outpatient services, nurse-led clinics, intermediate care.

Wildrige V & Bell L. How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/management information; HILJ 2002;19(2)113-5

4. MIP – Medical ethics questions

M Methodology e.g. in-depth interviews or questionnaires

I Issues e.g. Healthcare Rationing or end-of-life decision-making

P Participants e.g. physicians or patients

Strech D, Synofzik M, Marckmann G. Systematic reviews of empirical bioethics. J Med Ethics 2008;34:472-477

5. PICO – Reviews of interventions for health

P Patient or population

I intervention

C comparator

O Outcomes

Richardson W S, Wilson M C, Nishikawa J, & Hayward R S A.The well-built clinical question: A key to evidence-based decisions. ACP Journal Club 1995;123 A12-13.

Nb add ‘S’ on end if study type is significant, a ‘C’ if context is significant or 'T' for timeframe or 'T' Type of question

6. SPICE – Social science questions (designed for librarian research questions)

S Setting – Where? In what context?

P Perspective – For who?

I Intervention (Phenomenon of Interest)– What?

C Comparison – What else?

E Evaluation – How well? What result?

Booth A. Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech. 2006; 24(3), 355-68.

7. SPIDER – Qualitative evidence synthesis

S Sample

P I Phenomenon of interest

D Design

E Evaluation

R Research type

Cooke A; Smith D; Booth A; Beyond PICO : The SPIDER Tool for Qualitative Evidence Synthesis – Qual Health Res. 2012; 22(10) 1435-1443

*With thanks to Linda Mace-Michalik (The Library, Roseberry Park Hospital, TEWV NHS FT) for distributing her compilation of alternatives to the PICO framework.