Posing the Question Using PICOT

Posing the Question Using PICOT Focused foreground questions are essential to judiciously fi nd the right evidence to answer them (Schardt et al., 2007). Foreground questions should be posed using PICOT format. Thoughtful consideration of each component can provide a clearly articulated question. Table 2.1 provides a quick overview of the PICOT question components. Well-built, focused clinical questions drive the subsequent steps of the EBP process (The Cochrane Collaboration, 2006). The patient population (P) may seem easy to identify. However, without explicit description of who the population is, the clinician can get off on the wrong foot in searching. The Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Collaboration, 2006) suggests careful consideration of the patient and the setting of interest. Limiting the population to those in a certain age group or other special subgroup (e.g., young adult females with lung cancer) is a good idea if there is a valid reason for doing so. Arbitrary designations for the patient population will not assist the clinician in retrieving the most relevant evidence. The intervention or issue of interest (I) may include but is not limited to any exposure, treatment, diagnostic test, or predictor/prognostic factor, or it may be an issue that the clinician is interested in, such as fi bromyalgia or a new diagnosis of cancer. The more specifi cally the intervention or issue of interest is defi ned, the more focused the search will be. The comparison (C) needs special consideration as it is sometimes appropriate to include in a question and at other times does not need to be included. If the “I” is an intervention, the comparison can be a true control, such as a placebo, or another treatment, which is sometimes the usual standard of care. For example, a clinician wants to ask the question, in disabled, elderly patients (P), how does the use of level-access showers (I) compared to bed bathing (C) affect Melnyk_Chap02.indd 29 3/3/2010 12:47:08 PM Steps Zero, One, Two: Getting Started unit one 30 patient hygiene (O)? The intervention of interest is level-access showers, and the comparison is the usual care of bed bathing. In a meaning question, the “I” is an issue of interest. For example, a meaning question may be, How do parents (P) with children who have been newly diagnosed with cancer (I) perceive their parent role (O) within the fi rst month after diagnosis (T)? In this question, there is no appropriate comparison to the issue of interest, and “C” is not found in the question. The outcome (O) in the intervention example above is patient hygiene and the outcome of the meaning question above is the parental role. Specifi cally identifying the outcome (O) in a question enables the searcher to fi nd evidence that examined the same outcome variable, although the variable may be measured in various ways. In some questions, there may be more than one outcome of interest found in a study, but all of these outcomes fall under one umbrella. For example, the question may be, In preschool-age children, how does a fl avored electrolyte drink compared to water alone affect symptoms of dry mouth, tachycardia, fever, and irritability? Instead of formulating the question this way, it would be better to use the umbrella term dehydration for all these symptoms that are listed. The question would then be, In preschool-age children, how does a fl avored electrolyte drink compared to water alone affect dehydration (e.g., dry mouth, tachycardia, fever, irritability)? Specifying the outcome will assist the clinician in focusing the search for relevant evidence. table 2.1 PICOT: Components of an answerable, searchable question PICOT Patient population/disease The patient population or disease of interest, for example: • Age • Gender • Ethnicity • With certain disorder (e.g., hepatitis) Intervention or issue of interest The intervention or range of interventions of interest, for example: • Therapy • Exposure to disease • Prognostic factor A • Risk behavior (e.g., smoking) Comparison intervention or issue of interest What you want to compare the intervention or issue against, for example: • Alternative therapy, placebo, or no intervention/therapy • No disease • Prognostic factor B • Absence of risk factor (e.g., nonsmoking) Outcome Outcome of interest, for example: • Outcome expected from therapy (e.g., pressure ulcers) • Risk of disease • Accuracy of diagnosis • Rate of occurrence of adverse outcome (e.g., death) Time The time involved to demonstrate an outcome, for example: • The time it takes for the intervention to achieve the outcome • The time over which populations are observed for the outcome (e.g., quality of life) to occur, given a certain condition (e.g., prostate cancer) Melnyk_Chap02.indd 30 3/3/2010 12:47:08 PM Asking Compelling, Clinical Questions chapter 2 31 A time frame (T) associated with the outcome also may be part of asking a PICOT question. For example, In family members who have a relative undergoing cardiopulmonary resuscitation (P), how does presence during the resuscitation (I) compared to no presence (C) affect family anxiety (O) during the resuscitation period (T)? In the intervention example given earlier, there is no specifi c time associated with bathing or showering to achieve patient hygiene. However, for the meaning question example, it would be important to consider that the 1st month after diagnosis may be a critical time for parental role to be actualized for this population; therefore, a time frame is included in the question. To answer this question, studies would be sought that would have collected data to evaluate parental role for a period of a month after diagnosis. Time (T) and comparison (C) are not always appropriate for every question; however, population (P), intervention or issue of interest (I), and outcome (O) must always be present.