Clinical Questions

Evidence-based practice starts with asking an answerable question. This is a very important stage as the question drives the whole EBP process.  Efficiency is key in EBP process and the more you understand your question the more likely to obtain the right information in the most efficient manner. One way of building your clinical question is through identifying the key components which are known as the “PICO” framework. This stands for:


Who or what is the question about? Who are the
patients of interest? What is the health concern?

How would you describe a group of patients
similar to yours?

What are the most important characteristics of
the patient/population/problem? 
This may include the primary problem, disease, or co-existing
conditions. Sometimes particular age groups, gender or population may be
relevant to the diagnosis, prognosis or treatment of a disease.

Patient/ Population/

What therapeutic, diagnostic, preventative or
other healthcare interventions are you interested in knowing more about?

What do you want to do with this patient? e.g.
train them, educate them, prescribe a drug, order a diagnostic test,
consider surgical treatments etc.

What healthcare management strategies are you
interested in comparing?

What was the patient expose to? e.g. smoking


What is the main alternative
intervention/treatment to be evaluated against the intervention?

Your clinical question does not have to
always have a specific comparison.


What are you trying to accomplish, measure,
improve or affect? What are you trying to do for the patient?

How will the patient or population be affected,
or not affected, by the intervention? e.g. reduce the number of adverse
events? improve function/ prevent accidents?


There are two additional elements that are important to know:

What type of question you are asking?

What is the best type of study design to search for to find evidence to answer your clinical question?

So adding those to the PICO framework becomes PICOTT. PICO(TT) is very useful framework in helping you develop your clinical questions but at the same time is not without limits. This model works best for therapy/treatment and diagnostic questions. When developing your question remember that PICO(TT) is not a rigid structure.


Asking Clinical Questions

You need to select the highest strength of evidence available to answer your clinical question. Each type of question is answered best by specific types of research designs. Please use the table below as a guide to help you identify the research design that will best provide evidence to answer your question.


Types of question


Type of study design



Questions on how to select treatments or interventions that do more good than harm and that are worth the effort and cost

Randomised Control Trials (RCT)>cohort studies > case control studies> case series


Questions on how to identify the causes or origins of disease (i.e. Factors that produce or predispose toward a certain disease or disorder including genetics).

Cohort studies > case control  studies> case series


(clinical exam)

Questions on how to select and interpret diagnostic test, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety etc.

RCT> Prospective (cohort/case study) design, blind comparison to a gold standard



Questions addressing the prediction of the course of a disease, or how to estimate the patients clinical course over time and anticipation of likely complications of a disease

Cohort study > case control > case series


Questions addressing how one experiences a phenomenon.

Qualitative methodologies e.g. phenomenology, grounded theory, ethnography


Questions on understanding of how diseases and other healthcare related issues/problems can be prevented

RCT>Cohort studies

Quality improvement/

cost -effectiveness

Questions addressing issues of quality improvement or cost effectiveness of services such as how expensive services are, and whether they offer

value for money


Cost-effectiveness analysis

Evaluation studies

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