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Evidence Based Practice

To be able to ask a question clearly is two-thirds of the way to getting it answered.

- John Ruskin

Why do I need to focus my question?

PubMed alone contains over 30 million citations! It is so easy to get overwhelmed or distracted as you sift through all of the literature. Clearly defining your question can save you time by guiding you to design a precise search and narrowing in on what is relevant. A focused question can help prevent you from being misled by a study that addresses a question related to your topic, but with important differences, such as alternate outcomes, or different study populations.

It's important to note that these focused question types are designed for the purpose of clearly defining the key aspects of a question before searching the literature for previously-studied questions.


PICO, sometimes known as PICOTT, is a common approach for formulating clinical questions.







Patient / Population

Intervention / Indicator

Compare / Control



Type of Study or Question

Who are the relevant patients? Think about age, sex, geographic location, or specific characteristics that would be important to your question.

What is the management strategy, diagnostic test, or exposure that you are interested in?

Is there a control or alternative management strategy you would like to compare to the intervention or indicator?

What are the patient-relevant consequences of the intervention?

What time periods should be considered?  

What study types are most likely to have the information you seek?  What clinical domain does your question fall under?

Below are some examples of how PICO(TT) could be applied to different questions.  Note, not all questions will include all components of PICO(TT).  The important thing is that you are thinking through which concepts are most important for your question.


(P) Patient/Population; (I) Intervention/Indicator; (C) Compare/Control; (O) Outcome; (T) Time

Type of Study or Question

In perimenopausal women (P), what is the effect of taking hormone-replacement therapy (I) compared to nonhormonal therapy (C) on rate of mortality (O) five years later (T)?

Therapy: Randomized Controlled Trial > Controlled Trial or Quasi-Experimental Studies

In middle-aged men with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared with one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

Diagnosis: Cross-Sectional Studies or Gold Standard

Are kids (P) who have obese adoptive parents (I) at increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?

Etiology/ Harm: Cohort > Case-Control > Case Series

Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?

Prognosis/ Prediction: Cohort > Case-Control > Case Series

For OR nurses doing a five minute scrub (P) do natural polished nails and nail beds (I) reduce the presence and types of microbes (O) found at the time of surgery (T) compared with artificial nails (C)?

Prevention: Randomized Controlled Trial > Controlled Trial > Cohort > Case-Control 

How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?

Quality of Life/ Meaning: Qualitative studies

For more about PICO, see Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed (chapter 4)

Alternatives to PICO

Over 30 approaches to formulating a question have been documented in the literature. Some more commonly used approaches include:


SPIDER (for Qualitative research topics)
Sample Phenomenon of Interest Design Evaluation Research Type
The who of your question; often smaller than a population The how and why of certain behaviors, decisions, and individual experiences What's the framework? Survey, interview, observation, case study? What's the outcome? Views, attitudes, beliefs? Qualitative, quantitative, or mixed methods

Example: What are the experiences (E) of first year university students (S) in using their library (PI)?   [D= survey; R=qualitative]

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative health research22(10), 1435–1443.


ECLIPSE (for Management, Policy, or Economic Topics)
Expectation Client Location Impact Professionals Service
For what reason does the search requester want the information? At whom is the service aimed? Where does the service take place? What is the change in service, if any? What constitutes success? How is that measured? Who is providing/improving the service? For which service do you need information?

Example: There have been patient complaints about scheduling at our outpatient clinic (L). What changes to the process of scheduling appointments (Se) can the scheduling staff (P) make to improve the scheduling process (I) and improve patient satisfaction (E) for patients requiring scheduling (C)? 

Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/ management information. Health information and libraries journal19(2), 113–115.

For additional details on other question types: