Framing good questions

Once you’ve identified the core concepts of your topic using the PICO framework, how do you translate them into a question?

Describe the subject of the question.

It may be helpful to phrase the question in this form: “How would I describe a group of patients similar to this one? What are the relevant characteristics?”

Define which intervention you are considering for the specific patient or population.

It is sometimes helpful to name a second intervention with which to compare the first.

This might be another treatment, placebo, or ‘usual care.’

For example, diagnosis via a traditional X-ray is often compared to diagnosis with an MRI. However, it is not always necessary to include a comparison.

Define the type of outcome you wish to assess.

There are many possible outcomes. Try to focus on patient-oriented outcomes like death, disability or discomfort. These could include mortality, disease progression, results of a diagnosis test, confidence/anxiety, cost effectiveness and more.

Let’s take a look at our PICO examples from before.

Example 1

Patient/problem/population: mid-50s male with a 30 pack-year history of smoking
Intervention: bupropion
Comparison intervention: nicotine replacement therapy
Outcome: long-term abstinence from smoking

A well-built clinical question for these PICO elements would be: In a 55 year old man, would the administration of bupropion therapy versus nicotine replacement therapy lead to long-term abstinence from smoking?

Example 2

Patient/problem/population: woman in her 40s with no family history of breast cancer
Intervention: mammograms every three years
Comparison: yearly mammograms
Outcome: early detection of breast cancer

A well-built clinical question for these PICO elements would be: In a 42 year old woman with no family history of breast cancer, are mammograms every three years as effective in detecting breast cancer as yearly mammograms?

Here are some other examples of clinical questions. Even though we don’t have the example clinical scenario or the PICO frameworks for the below questions, you can easily tell what the most important elements of the patient scenarios are:

  • In a 50 year old man with low back pain, is physical therapy as effective at relieving pain as surgery?
  • In a 34 year old woman with chronic cold sores, does taking zinc work help to prevent cold sores?


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