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NSG607: Evidence-Based Practice: ASK: PICOT

Course Guide for NSG607

Searchable Questions

In EBP, clinical questions are asked in PICOT format (i.e., Patient population, Intervention or Issue of Interest, Comparison intervention or group, Outcome, and Time frame) to yield the most relevant and best evidence. 

PICO(T)

PICO(T) is a mnemonic used to describe the five elements of a good clinical question. 

Pstands for Patient, Population, or Problem

Who is the patient(s) or population and what is their particular condition or healthcare problem?

  • Adult African-American patients with hypertension (age, ethnicity)
  • Elderly patients at risk for influenza (age)
  • Elementary school-age children with attention-deficit disorder (age)
  • Low-income Latino children exposed to second-hand smoke (age, ethnicity, economic status)
  • 45 y/o Asian woman with asymptomatic mitral valve prolapse (age, ethnicity, gender)

stands for Intervention  or Issue of Interest

What are the main interventions or exposures in my question?

  • Therapeutic: diet rich in fruits, vegetables, legumes, and low in salty snacks and sweets (for high blood pressure)
  • Preventive: influenza vaccination
  • Diagnostic: CT Scan (head injury)
  • Harm/Etiology: exposure to a Rx, disease, or other risk factor (second-hand smoke)
  • Prognostic factor: moderate to severe mitral regurgitation

C

 stands for Comparison Intervention or Group

Does your question include a "counter intervention" or exposure, e.g., a recognized standard, or the absence of treatment or exposure?

  • Therapeutic/Preventative: blood pressure medication, no influenza vaccination
  • Diagnostic: clinical observation only of patient with head injury
  • Harm Etiology: no exposure to cigarette smoke (absence of risk factor)
  • Prognostic factor: mild mitral regurgitation

Ostands for Outcome

 

Outcomes of interest from a clinical and patient perspective; what do you want to accomplish?

Will this intervention/exposure:

  • increase or decrease the risk of disease?
  • affect the accuracy of diagnosis?
  • improve quality of life?
  • lead to greater patient comfort
  • affect the rate of occurrence of adverse outcome, e.g., morbidity, mortality

Tstands for Time/Type

  • Time it takes to demonstrate a clinical outcome
  • What is the duration of your data collection?
    • Flu Season
    • Once weekly for 6 weeks
    • Within 3 months
  • Type of Question/Study
    • Therapy/Treatment
    • Diagnosis
    • Prognosis
    • Harm/Etiology

Good Clinical Questions

Two additional elements of the well-built clinical question are the type of question and the type of study. This information can help focus the question and determine the most appropriate type of evidence or study.

For a definition of study types see the Useful Definitions Tab on the EBP Page.

Common Question Types

THERAPY (treatment)

How to select treatments that do more good than harm and are worth the efforts and costs

Example of a Therapy Question           

Explanation

  • Most frequently asked.
  • Questions about the effectiveness of interventions in improving outcomes in sick patients and patients suffering from some condition.
  • Clinician treatments are most likely medications, surgical procedures, exercise, counseling about lifestyle changes.    

Type of Study

Randomized controlled trial, cohort study

DIAGNOSIS

How to select and interpret diagnostic tests

Example of a Diagnosis Question

Explanation

  • Questions about the ability of a test or procedure to differentiate between those with and without a condition or disease.

Type of Study

Prospective, blind comparison to a gold standard or cross-sectional

PROGNOSIS (forecast)

How to estimate the patient’s likely clinical course over time (based on factors other than the intervention) and anticipate likely complications of disease.

Example of a Prognosis Question

Explanation

  • Questions about the probable cause of a patient’s disease or the likelihood that s/he will develop an illness.

Type of Study

Cohort study, case control, case series

HARM/ETIOLOGY (causation)

How to identify causes for disease (including iatrogenic forms)

Example of an Etiology Question

Explanation

  • Questions about the harmful effect of an intervention or exposure on a patient.                                       

Type of Study

Cohort study, case control, case series

Adapted from: Fineout-Overholt, E. & Johnston, L. (2005), Teaching EBP: asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160. doi: http://dx.doi.org/10.1111/j.1741-6787.2005.00032.x

Formulating Answerable Clinical Questions is the Foundation of EBP!

Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions.

  1. Start with the patient: clinical problems and questions arise out of patient care
  2. Translate the clinical questions into a searchable question using PICOT
  3. Decide on the best type of study to address the question
  4. Perform a literature search in the appropriate source(s)

Is your clinical question answerable?

  • "What is the best treatment for recurrent UTI in children?" is so broad that a meaningful answer is difficult to find due to the large number of articles you may retrieve addressing many possible treatments and clinical outcomes. 
  • "In children with recurrent UTI, is cranberry juice effective in reducing the number of recurrences?" is more focused and will lead to a doable search strategy. 

Express your clinical question in the PICO format

  • P - Patient or Population AND Problem
  • I - Intervention: a treatment, a diagnostic test, an exposure to a known or presumed risk factor, etc.
  • C - Comparison: treatment, placebo, gold standard diagnostic test, absence of risk factor, etc. 
  • O - Clinical outcome of interest
  • T - Time frame it should take you to determine whether your interventions had any affect or Type of Question Asked

The PICOT terms come from and should match your clinical question.