A good clinical question: Clinically relevant to your patient, specific, and yields a valid and applicable answer.
PICO: Components of a good clinical question
- Patient or problem: What are the characteristics of the patient? The disease process?
- Intervention or issue of interest: What is the problem that you want to address? Diagnostic? Rx? Prognosis?
- Comparison: Are there comparisons for the test or intervention? Test A vs Test B? New drug vs standard drug?
- Outcomes: What are the clinical outcomes of interest? (e.g., reduction in mortality)
Sample format for a clinical question:
In (Patient), how does (Intervention) (Compare) to alternate intervention in achieving (Outcome)?
Clarify your question: The type of question matters and influences your search for and interpretation of the answer. The question may relate to any aspect of care, e.g. diagnosis, prognosis, treatment, etiology, potential harms from treatments, prevention, or value.
Example:
In a 72 yo M with a history of HTN, HLD and GERD who presents with streaks of blood on toilet paper…
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Common Questions |
Characteristics |
Choose wisely... |
|---|---|---|
|
Diagnosis |
…does FOBT predict risk for colorectal cancer (CRC)? What disease does my patient have? How to select the right test? How to interpret a test result? Will the test change management? |
“Over-diagnosis” or unnecessary testing may be difficult to interpret, obscure the true etiology, be costly, inaccurately label patients, place strain on the patient and family, and lead to unneeded interventions. |
|
Therapy |
…is colonoscopy with polyp removal better than “watchful waiting” for possible CRC? What should I do? Will this intervention lead to a desirable outcome? Prevent or modify disease course? What is the right treatment to maximize benefit and minimize harm? |
Therapies may not apply to your particular patient and comorbidities, may have limited benefit and be costly, harmful, or outcomes may be inconsistent with patient values or expectations. |
|
Prognosis |
…what will be his clinical course if he develops CRC? What will happen to my patient? Can we reliably inform the patient? |
Prognosis must be placed in the context of the patient’s comorbidities and unique preferences, expectations and values. |