Formulating a PICOT Question

September 26, 2020

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Whether
they’re finishing advanced studies in nursing school or working in a professional clinical setting,
registered nurses (RNs) begin their research queries using an evidence-based practice framework
developed from a well-constructed PICOT question.

The word PICOT is a mnemonic derived from the elements of a clinical research question – patient,
intervention, comparison, outcome and (sometimes) time. The PICOT process begins with a case
scenario, and the question is phrased to elicit an answer.

“The question needs to identify the patient or population we intend to study, the intervention or
treatment we plan to use, the comparison of one intervention to another (if applicable) and the
outcome we anticipate,” Kathy A. Jensen, MHA, RN, wrote in EBSCO Health’s whitepaper, “7 Steps
To The Perfect Pico Search.” “Once a well-structured question is formulated, researchers will be in a
better position to search the literature for evidence that will support their original PICO question.”

For RNs who are training in a doctor of nursing practice (DNP) program, including an online DNP
program, learning how to develop a comprehensive PICOT question is essential to nurse manager
competencies. DNP students study PICOT question examples to determine the best process for
crafting a question and finding an answer.

Learning the PICOT Process

The PICOT process generally begins with a vague clinical query. Each element of the process
helps develop a well-structured question. Once established, researchers can search for evidence
that will help answer the inquiry.
The elements of a PICOT question are:

P (Patient, population or problem)

Who or what is the patient, population or problem in question?

I (Intervention)
What is the intervention (action or treatment) being considered?

C (Comparison or control)
What other interventions should be considered?

O (Outcome or objective)
What is the desired or expected outcome or objective?

T (Time frame)
How long will it take to reach the desired outcome?

Using the PICOT process helps develop a careful and thoughtful question that makes the search for
evidence easier, the University of Oxford’s world-renowned Centre for Evidence-Based Medicine
said.

“The well-formed question makes it relatively straightforward to elicit and combine the appropriate
terms needed to represent your need for information in the query language of whichever searching
service is available to you,” the University of Oxford author said. “Once you have formed the
question using the PICO structure, you can think about what type of question it is you are asking,
and therefore what type of research would provide the best answer.”

Steps to the PICOT Process

In developing a PICOT question, researchers must identify a need or a reason for the study. In the
EBSCO Health whitepaper, the general example used is this: A committee decides to conduct a
case study to determine whether postoperative gum chewing for abdominal surgery patients can
prevent postoperative ileus (lack of intestinal movement).
With the scenario in mind, researchers use seven steps to the PICOT search:

1. Formulate the PICOT question in general terms: Based on the EBSCO Health example, the
research question would be, “In patients recovering from abdominal surgery, is there
evidence that suggests gum-chewing postoperatively, compared to not chewing gum,
impacts postoperative ileus?”
 2. Identify the keywords for the PICOT mnemonic:
P – Patients recovering from abdominal surgery
I – Gum chewing
C – Not chewing gum
O – Impacts post-operative ileus
3. Plan the search strategy: With the question in mind, researchers consider which databases
and other search sites they might use to find information and answers. Researchers use
strategies to maximize their search terms such as looking up synonyms and phrases that
mean the same thing.
4. Execute a search: At first, researchers search each PICOT element individually. For
example, when researching patients recovering from abdominal surgery, use the search
terms “abdominal surgery,” but also consider the search terms “recovery and postoperative.”
5. Refine the results: Narrow the search results by limiting the works to pertinent content, such
as articles from peer-reviewed journals or research documents.
6. Review the content: Review the research results to establish if they have the necessary
information to answer the PICOT question.
7. Determine if research results meet standards: After reviewing the research results,
determine whether they provide the best available evidence.
After the PICOT question is constructed and researched, the information garnered is used to
determine which type of study is most appropriate. Study types include meta-analysis, systematic
review, randomized controlled trial, cohort study, case-control study and case report.

“The actual search for high-quality clinical research evidence can be overwhelming to many,” Jensen
said in the EBSCO Health whitepaper. “By utilizing the PICO format, the search process will be
streamlined and will yield the best available evidence to support clinical decisions and explore
alternative treatments and procedures.”

DNP and PICOT Question

To take a deep dive into advanced nursing practice, many RNs seeking a DNP must submit a final
project. At Duquesne University, online DNP program students undertake a DNP Practice Project,
which must focus on patient outcomes, quality improvements and clinical practice.

Through the project, Duquesne University DNP candidates will identify a specific problem in patient
care or clinical practice and present solutions. Students use a PICOT question to guide the project
topic.

The online DNP program at Duquesne University teaches RNs nurse manager competencies as well
as other essential leadership skills. The university offers three distinct DNP tracks:
 Clinical Leadership DNP
 Post-Bachelor’s Executive Nurse Leadership DNP
 Post-Master’s Executive Nurse Leadership DNP
About Duquesne University’s Online DNP Program

Duquesne University, a leader in online education, prepares RNs for clinical leadership positions as
DNPs. The university’s curriculum builds on existing experiences and knowledge so graduates can
implement evidence-based practice in clinical settings.

Duquesne University’s online DNP program provides RNs an opportunity to continue their
professional career and maintain family responsibilities while earning an advanced degree.
Sources
EBSCOHealth, “7 Steps to The Perfect Pico Search”
University of Oxford, “Asking Focused Questions”
Duquesne University, “Systematic Reviews: Developing a research question”

To formulate questions in Evidence Based Practice, use the PICOT format.

PICOT stands for:

 Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race,
sex)
 Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)
 Comparison: What is the alternative to your plan? (ie. No treatment, different type of
treatment, etc.)
 Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health, etc.)
 Time: What is the time frame? (This element is not always included.)

Your PICOT question will fall under one of these types:

 Therapy/Prevention
 Diagnosis
 Etiology
 Prognosis

The documents in the box on the left to find which level of research is appropriate for your type of
PICOT question.