PICO and the 5 A's
PICO is an acronym for Patient, Intervention, Comparison, and Outcome. PICO is used to help create an answerable clinical question.
PATIENT, POPULATION, OR PROBLEM
Who is the patient? What is the health issue/problem?
INTERVENTION
What main intervention are you considering? What do you want to do with this patient?
COMPARISON
What is the main alternative being considered, if any?
OUTCOME
What are you trying to accomplish, measure, improve or affect?
TIME (optional)
Length of treatment
From Dayton Memorial Library, use this worksheet to help formulate your PICO question and search.
PICO examples
|
Question Type |
Patient or Problem |
Intervention or Exposure |
Outcome |
Comparison |
|---|---|---|---|---|
|
Therapy |
In patients with hypertension and at least one additional cardiovascular disease risk factor |
Does tight systolic blood pressure control |
Lead to lower rates of myocardial infarction, stroke, heart failure, and cardiovascular mortality |
Compared to conservative control? |
|
Diagnosis |
Among asymptomatic adults at low risk of colon cancer |
Is fecal immunochemical testing (FIT) |
As sensitive and specific for diagnosing colon cancer |
As colonoscopy? |
|
Prognosis |
Among adults with pneumonia |
Do those with chronic kidney disease (CKD) |
Have a higher mortality rate |
Than those without CKD? |
|
Etiology or Harm |
Are women |
With a history of pelvic inflammatory disease (PID) |
At higher risk for gynecological cancers |
Than women with no history of PID? |
|
Prevention |
Among adults with a history of myocardial infarction |
Does adherence to a Mediterranean diet |
Lower risk of a second myocardial infarction |
Compared to those who do not adopt a Mediterranean diet? |
Chart credited to: The Icahn School of Medicine at Mount Sinai. (2025). Evidence Based Medicine: The PICO Framework. Levy Library Guides. https://libguides.mssm.edu/ebm/ebp_pico.
The 5 A's are used as a framework to help approach a clinical question.
|
1. ASSESS |
Look at a clinical policy/clinical practice guideline at your workplace or perhaps at the National Guideline Clearinghouse website and identify a problem or need in the policy/clinical practice guideline OR review a current nursing practice issue.
|
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2. ASK |
Construct a well built question related to the problem or need you have identified in the policy or practice issue. |
|
3. ACQUIRE |
Select the appropriate resource(s) and conduct a search. Look for at least 5 scholarly/research articles/reviews that address all three legs of the EBP stool: patient values and preferences, scientific evidence, and clinical experience.
|
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4. APPRAISE |
Critique the evidence. Use Journal Grid to appraise for its validity (closeness to the truth)and applicability (usefulness in clinical practice). Identify level of evidence.
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5. APPLY |
Integrate best scientific evidence, clinical experience, patient values and preferences and apply it to practice.
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7. FEASIBILITY (Optional) |
Briefly discuss the influence of stakeholders /change agents as they might influence the viability of your evidence-based recommendations. |