Faculty of Health and Medical Sciences

Formulate a Clinical Question

Translate a knowledge gap into a clinical question

Translating a knowledge gap into an answerable and well constructed clinical question is an important skill.

A well built clinical question:

  1. gives you a head start in finding information that is relevant (applicable to the patient) and valid (accurately measures what the authors state they intend to measure.)
  2. provides you with a checklist for the main concepts to be included in your search strategy.
  3. allows you to find information quickly. If tracking down the evidence takes too long, you will probably avoid it in your clinical practice.

The PICO framework is an effective tool for constructing a WBCQ.

Click on each of the letters below to identify the PICO elements from a range of clinical questions.

P

Population

Ask: How would I describe a group of patients similar to mine?

The patient problem or situation. When building your question, this is easier if you characterise your patient sufficiently to allow comparison with patients in the studies you find, perhaps in terms of age, sex, ethnic group, risk profile and other clinically important traits.

I

Intervention (or exposure/prognostic factor)

Ask: Which main intervention am I considering?

The intervention you wish to assess could be:

  • Therapy (drugs or procedure)
  • Prevention (eg, lifestyle counselling)
  • Diagnostic testing (eg. How much more likely is your patient to have had a myocardial infarction if the test is positive?)
  • Aetiology/Harm (eg. To what extent are smokers at risk of lung cancer?)

C

Comparison Intervention (or exposure/prognostic factor)

Ask: What is the main alternative?

What is the main alternative or treatment to the intervention being considered, if any? Are you trying to decide between two drugs, a drug and no medication or placebo, surgical techniques or two diagnostic tests? Exposure vs no exposure? Your clinical question doesn't always have to have a specific comparison.

O

Outcome

Ask: What could this intervention affect?

What you wish to achieve in terms of treatment goals, adverse effects to avoid, diagnoses to refine, etc. What are you trying to accomplish, measure, improve or affect. A precise endpoint must be defined. It could be survival or death, remission or cure, disability prevention, recovery of function and savings in time or money. Patients will also be concerned about endpoints such as side effects, quality of life, operative morbidity and time in hospital. Health care payers may be concerned about cost effectiveness of an intervention.

See this example of a patient encounter which shows some of the clinical questions that may arise and how they translate into the PICO framework.