What is a 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.

You can format your PICOT question in five different ways depending on nursing problem and aim. The five ways to format a PICOT question include intervention PICOT question format, etiology PICOT question format, diagnosis PICOT question example, Meaning PICOT Question Format, Prognosis PICOT Question Format, and Prevention PICOT Question Format.

Read more on nursing PICOT Question examples and ideas

How to Format a PICOT Question – PICOT Question Templates and Examples

1. Intervention PICOT Question Format

1. Intervention/Therapy/Treatment approach – which is used to determine which treatment leads to the best outcome. This PICOT format focuses on the effectiveness of interventions in improving patient outcomes. Intervention picot questions require randomized controlled trials (RCT) to answer the clinical question.

Here’s a Intervention PICOT Question template 

Questions addressing how a clinical issue, illness, or disability is treated.

“In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?

Framing a PICOT Questions

Intervention PICOT Question Examples

Here are 10 examples of Intervention PICOT Questions:

1. In patients with diabetes (P), how does lifestyle modification (I), compared to medication therapy (C) affect glycemic control (O)?
2. In individuals with hypertension (P), how does aerobic exercise (I) compare to dietary changes (C) in affecting blood pressure (O)?
3. In children with attention deficit hyperactivity disorder (P), how does behavior therapy (I) compared to medication treatment (C) affect academic performance (O)?
4. In cancer patients undergoing chemotherapy (P), how does acupuncture (I), compared to antiemetic medications (C), affect nausea and vomiting (O)?
5. In elderly individuals with chronic pain (P), how does physical therapy (I), compared to opioid analgesics (C), affect functional mobility (O)?
6. In pregnant women with gestational diabetes (P), how does a low-carbohydrate diet (I) compared to standard prenatal care (C) affect birth weight (O)?
7. In patients with depression (P), how does cognitive-behavioral therapy (I), compared to antidepressant medication (C), affect symptom remission (O)?
8. In stroke survivors (P), how does robotic-assisted therapy (I) compared to conventional therapy (C) affect upper limb function (O)?
9. In patients with chronic obstructive pulmonary disease (P), how does pulmonary rehabilitation (I), compared to pharmacotherapy (C), affect exercise tolerance (O)?
10. In individuals with insomnia (P), how does mindfulness meditation (I) compared to sleep medication (C) affect sleep quality (O)?

2. Etiology PICOT QUESTION Format

Etiology PICOT QUESTION Template

Etiology Picot questions are clinical questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

“Are_________________(P), who have_________________(I) compared with those without _________________ (C) at _________________risk for/of_________________(O) over_________________(T)?” 

Framing a PICOT Questions

Etiology PICOT QUESTION Examples

1. Are smokers (P), who are exposed to secondhand smoke (I) compared to non-smokers (C), at higher risk for lung cancer (O) over a 10-year period (T)?
2. Are pregnant women with gestational diabetes (P) compared to those without gestational diabetes (C), at increased risk of developing type 2 diabetes (O) within five years postpartum (T)?
3. Are individuals with a family history of heart disease (P) who follow a Mediterranean diet (I) compared to those who do not (C), at lower risk for coronary artery disease (O) over a 20-year period (T)?
4. Are children exposed to high levels of air pollution (P) compared to those living in low pollution areas (C), at increased risk for asthma (O) over 5 years (T)?
5. Are obese adults (P) who undergo bariatric surgery (I) compared to those who opt for conventional weight loss methods (C), at greater risk for nutritional deficiencies (O) within one-year post-surgery (T)?
6. Are individuals who experience childhood trauma (P), compared to those without trauma (C), at higher risk for developing post-traumatic stress disorder (O) in adulthood (T)?
7. Are elderly individuals (P) who regularly engage in physical exercise (I), compared to sedentary individuals (C), at lower risk for age-related macular degeneration (O) over 10 years (T)?
8. Are individuals with a history of alcohol abuse (P) who receive counseling (I) compared to those without counseling (C) at reduced risk for relapse (O) over 2 years (T)?
9. Are pregnant women who consume high amounts of caffeine (P) compared to those who limit caffeine intake (C), at increased risk for preterm birth (O) within 37 weeks gestation (T)?
10. Are shift workers (P) who take melatonin supplements (I), compared to those who do not (C), at lower risk for developing sleep disorders (O) over 6 months (T)?

3. Diagnosis PICOT Question Format, template, and examples

Diagnosis PICOT Questions focus on the ability of a test or procedure to differentiate between those with and without a condition or disease. The PICOT question addresses the act or process of identifying or determining the nature and cause of a disease or injury through evaluation. The type of evidence required to answer a diagnosis PICOT question is either RCT or a Cohort Study.

Diagnosis PICOT Question Template

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Framing a PICOT Questions

10 Diagnosis PICOT Questions Examples 

1. In elderly patients over 75 (P), is the use of 3D echocardiography (I) compared with traditional 2D echocardiography (C) more accurate in diagnosing valvular heart disease (O)?
2. In adult diabetic patients (P), is MRI imaging (I) compared with CT scans (C) more accurate in diagnosing pancreatic cancer (O)?
3. In children with suspected appendicitis (P), is ultrasound examination (I) compared with clinical evaluation alone (C) more accurate in diagnosing appendicitis (O)?
4. In pregnant women (P), is cell-free DNA testing (I) compared with standard serum screening tests (C) more accurate in diagnosing chromosomal abnormalities (O)?
5. In individuals with a family history of colorectal cancer (P), is virtual colonoscopy (I) compared with conventional colonoscopy (C) more accurate in diagnosing colorectal polyps or cancer (O)?
6. In patients suspected of having a pulmonary embolism (P), are CT pulmonary angiograms (I) compared with V/Q scans (C) more accurate in diagnosing a pulmonary embolism (O)?
7. In middle-aged adults presenting with chest pain (P), is coronary CTA (I) compared with exercise stress testing (C) more accurate in diagnosing coronary artery disease (O)?
8. In neonates suspected of having sepsis (P), is multiplex PCR testing of blood samples (I) compared with blood culture alone (C) more accurate in diagnosing bacterial sepsis (O)?
9. In adults presenting with cognitive decline(P), is PET imaging using amyloid markers(I) compared with cerebrospinal fluid analysis(C) more accurate in diagnosing Alzheimer’s disease(O)? 
10. In individuals at risk for HIV infection(P), is fourth-generation ELISA testing(I) compared with third-generation ELISA tests(C) more accurate in diagnosing HIV infection(O)? 

4. Meaning PICOT Question Format

Questions address how one experiences a phenomenon or why we must approach practice differently. Such PICOT questions are used to determine the meaning of an experience for a particular individual, group or community. The type of evidence to answer the question is a qualitative study.

Meaning PICOT Question Template

How do_________________(P) with_________________(I) perceive_________________(O)?

Framing a PICOT Questions

Here’s a list of 10 Examples of Meaning PICOT Questions

1. How do elderly patients (P) with chronic pain (I) perceive the effectiveness of alternative therapies (O)?
2. How do parents (P) using sign language (I) perceive its impact on the communication abilities of their deaf children (O)?
3. How do cancer survivors (P) participating in support groups (I) perceive the quality of their social interactions (O)?
4. How do teenagers (P) with acne (I) perceive the social implications of their skin condition (O)?
5. How do pregnant women (P) practicing prenatal yoga (I) perceive changes in their stress levels (O)?
6. How do individuals with depression (P) undergoing cognitive-behavioral therapy (I) perceive changes in their mood and daily functioning (O)?
7. How do teachers (P) implementing technology-based learning tools (I) perceive student engagement in the classroom setting (O)?
8. How do nurses (P) using mindfulness techniques during shifts (I) perceive their job-related stress levels and job satisfaction(O)?
9. How do amateur athletes (P) adopting a plant-based diet (I) perceive their athletic performance and recovery times(O)?
10. How do patients with diabetes(P) utilizing telemedicine services(I) perceive the management of their disease(O)?

5. Prognosis PICOT Question Format

A prognosis PICOT Question format focuses on a clinical inquiry about the probable cause of a patient’s disease or the likelihood that he or she will develop an illness. The question investigates the occurrence or course of a disease.

Prognosis/Prediction picot question Template

In_________________(P), how does_________________(I) compared to_________________ (C) influence _________________ (O)?

Framing a PICOT Questions

Here’s 10 Prognosis PICOT Question Examples 

1. In adults over 50 years of age (P), how does the presence of chronic high blood pressure (I) compared to normal blood pressure (C) influence the likelihood of developing dementia (O)?
2. In teenagers with type 1 diabetes (P), how does intensive insulin therapy (I) compared to conventional insulin therapy (C), influence long-term cardiovascular outcomes (O)?
3. In women with previous gestational diabetes (P), how does a lifestyle intervention program emphasizing diet and exercise (I) compared to no structured lifestyle changes (C) influence the development of type 2 diabetes postpartum (O)?
4. In individuals with a family history of melanoma (P), how does regular dermatological screening (I) compare to irregular or no screening (C) influence early detection and prognosis of melanoma (O)?
5. In patients diagnosed with stage II colon cancer (P), how does adjuvant chemotherapy (I) compare to surgery alone (C) influence five-year survival rates (O)?
6. In obese children and adolescents (P), how does bariatric surgery (I), compared to lifestyle interventions alone (C), influence the resolution of co-morbid conditions like type 2 diabetes or hypertension (O)?
7. In patients with acute ischemic stroke (P), how does initiating thrombolytic therapy within three hours of symptom onset (I) compared to three hours from symptom onset (C) influence functional outcomes at one-year post-stroke (O)?
8. In elderly patients with chronic kidney disease (P), how does a low-protein diet supplemented with keto acids/amino acids(I) compared to normal protein intake(C) influence progression to end-stage renal disease(O)?
9. In individuals recently diagnosed with HIV/AIDS(P), how does starting antiretroviral therapy early in the disease course(I) compared to during later stages(C) influence mortality rates(O)?
10. In smokers with chronic obstructive pulmonary disease(COPD)(P), how does the use of e-cigarettes(I) compared to traditional nicotine replacement therapies(C) influence exacerbation rates(O)?

Prevention PICOT Question Examples

Questions about the effectiveness of an intervention or exposure in preventing morbidity and mortality. Similar to treatment questions. When assessing preventive measures, it is particularly important to evaluate potential harms and benefits. The type of question to answer a Prevention PICOT question is RCT or Prospective Study.

Here are 10 Prevention PICOT Question Examples :

1. In adults aged 65 and older, does the administration of the influenza vaccine (compared to no vaccination) decrease the incidence of flu-related hospitalizations?
2. In pregnant women, does the use of prenatal vitamins (compared to no prenatal vitamins) reduce the risk of neural tube defects in newborns?
3. In individuals with a family history of colorectal cancer, does regular screening with colonoscopy (compared to no screening) decrease the incidence of advanced-stage colorectal cancer?
4. In smokers, does the use of nicotine replacement therapy (compared to no therapy) increase the success rate of smoking cessation at 6 months?
5. In patients with hypertension, does regular physical exercise (compared to no exercise) reduce the risk of cardiovascular events?
6. In children under the age of 5, does the implementation of hand hygiene practices in childcare settings (compared to no practices) decrease the transmission of respiratory infections?
7. In patients with type 2 diabetes, does the use of metformin (compared to no medication) delay the progression to diabetic retinopathy?
8. In individuals at high risk for HIV infection, does the use of pre-exposure prophylaxis (PrEP) (compared to no PrEP) reduce the risk of acquiring HIV?
9. In postmenopausal women, does hormone replacement therapy (compared to no therapy) decrease the incidence of osteoporotic fractures?
10. In patients undergoing major surgery, does the administration of prophylactic antibiotics (compared to no antibiotics) lower the risk of surgical site infections?

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 to help answer the inquiry.

The elements of a PICOT question are:

• P (Patient, population, or problem) – Who or what is the patient, population, or issue in question?
• I (Intervention) – What intervention (action or treatment) is 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?

The PICOT process helps develop a careful and thoughtful question that makes the search for evidence easier.

Steps to the PICOT Process – Example of how to incorporate PICOT question into Research paper

In developing a PICOT question, researchers must identify a need or a reason for the study.

With the scenario in mind, researchers use seven steps in 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 them, 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.

Sources

EBSCO Health, “7 Steps to The Perfect Pico Search”
University of Oxford, “Asking Focused Questions”