When searching for evidence-based practice studies in medical databases, you must first develop a well-built clinical question. In Evidence Based Practice, PICO framework is used to form the question and facilitate search in databases.
|
Framework item |
Item Question |
Example |
|
Patient Problem (or Population) |
What are the patient's demographics such as age, gender and ethnicity? Or what is the problem type? |
Work-related neck muscle pain |
|
Intervention |
What type of intervention is being considered? For example is this a medication of some type, or exercise, or rest? |
Strength training of the painful muscle |
|
Comparison or Control |
Control Is there a comparison treatment to be considered? The comparison may be with another medication, another form of treatment such as exercise, or no treatment at all. |
Rest |
|
Outcome |
What would be the desired effect you would like to see? What effects are not wanted? Are there any side effects involved with this form of testing or treatment? |
Pain relief |
The PICO(T) Model
It is useful to think about what type of question it is you are asking, (therapy, prevention, diagnosis, prognosis, etiology). The table below illustrates ways in which Patient Problem, Interventions, Comparisons and Outcomes vary according to the type of question.
|
Question Type |
Patient Problem or Population |
Intervention or Exposure |
Comparison |
Outcome Measures |
|
Therapy (Treatment) |
Patient’s disease or condition; characteristics of a population (age, gender, ethnicity, etc.). |
A therapeutic measure, eg., medication, surgical intervention, or lifestyle change. |
Standard care, another intervention, or a placebo. |
Mortality rate, number of days off work, pain, disability. |
|
Prevention |
Patient's risk factors and general health condition |
A preventive measure, e.g., A lifestyle change or medication. |
Another preventative measure OR maybe not applicable. |
Mortality rate, number of days off work, disease incidence. |
|
Diagnosis |
Specific disease or condition. |
A diagnostic test or procedure. |
Current "reference standard" or "gold standard" test for that disease or condition. |
Measures of the test utility, i.e. sensitivity, specificity, odds ratio. |
|
Prognosis |
Duration and severity of main prognostic factor or clinical problem. |
Usually time or "watchful waiting". |
Usually not applicable. Identify the standard treatment if your question is about “watchful waiting”. |
Survival rates, mortality rates, rates of disease progression. |
|
Etiology |
Patient's risk factors, current health disorders, or general health condition. |
The intervention or exposure of interest. Includes an indication of the strength/dose of the risk factor and the duration of the exposure. |
Usually not applicable. |
Survival rates, mortality rates, rates of disease progression. |
Therapy
In ___[P]___, do/does ___[I]___ result in ___[O]____ when compared with ___[C]___ over ___[T]____?
E.g.) In nursing home residents with osteoporosis, do hip protectors result in fewer injuries from slips, trips, and falls when compared with standard osteoporosis drug therapy over the course of their stay?
Etiology
Are ___[P]___ with ___[I]___ over ____[T]____ more likely to ___[O]____ when compared with ___[C]___ ?
E.g.) Are female non-smokers with daily exposure to second-hand smoke over a period of ten years or greater more likely to develop breast cancer when compared with female non-smokers without daily exposure to second-hand smoke?
Diagnosis
Is/are ___[I]___ performed on ___[P]___ more effective than ___[C]___ over ___[T]____in ___[O]____?
E.g.) Are self-reporting interviews and parent reports performed on children aged 5-10 more effective than parent reports alone over a four-week consultation process in diagnosing depression?
Prevention
In ___[P]___, do/does ___[I]___ result in ___[O]____ when compared with ___[C]___ over ___[T]____?
E.g.) In emergency room visitors, do hand sanitizing stations result in fewer in-hospital infections when compared with no hand sanitizing stations over a year-long pilot period?
Prognosis
Do/does ___[I]___ performed on ___[P]___ lead to ___[O]___ over ___[T]____compared with ___[C]____?
E.g.) Do regular text message reminders performed on patients recently diagnosed with diabetes lead to a lower occurrence of forgotten insulin doses over the first six months of treatment compared with no reminders?
Material from this section is based on the McMaster University Nursing LibGuide https://hslmcmaster.libguides.com/nursing/questions