Applied Evidence Based Medicine

• Understand how to use PICO to formulate a prognosis question
• Become familiar with pre-appraised clinical tools
• Know where to look for prognostic decision tools

When using PICO to frame a prognosis question, the P is the patient, population, or problem; the I is the prognostic factor; the C is usually not applicable; and the O is the outcome of interest (e.g., mortality, recurrence). Many prognosis questions only require a population and an outcome because they often relate to broad populations rather than comparing subgroups. 

Here are a couple of prognosis scenarios and how you would break them down using PICO:

Scenario 1: Your patient is a 70-year-old man who was recently diagnosed with dementia, most likely Alzheimer's. He comes to his appointment with his daughter who wants information on the progression of the disease and whether it will increase his risk of death. Her father has named her as his decision-maker for personal care and finances. She wants to start planning for his future care as he has been living alone. 

P: elderly man with newly diagnosed dementia

I: (not applicable)

C: (not applicable)

O: risk of death

Clinical Question: In a 70-year-old man with newly diagnosed dementia, what is the risk of death?

Scenario 2: The parents of a 25-year-old patient with schizophrenia are concerned about their son's future health. They ask you about the possibility of relapse. 

P: 25-year-old male with schizophrenia

I: (not applicable)

C: (not applicable)

O: relapse

Clinical Question: What is the likelihood of relapse in a 25-year-old with schizophrenia?