(2022). Vitalsource.com. https://full-bookshelf.vitalsource.com/reader/books/9781975135973/epubcfi/6/44[vnd.vst.idrefbody21]!/4/2/14/8/8/10/3:255[ofev]
PICO: Defining the Clinical Question
There was a significant increase in awareness about patient care outcomes and the associated factors beginning in the 1990s for medicine and nursing. Richardson et al. (1995) introduced the PICO process for asking a research question, without using the PICO acronym. The PICO process is a standard used today to investigate evidence-based care in medicine and nursing (Caldwell et al., 2012; Considine et al., 2017; Echevarria & Walker, 2014; Yensen, 2013).
ʿP—patient, problem, or population (e.g., age, ethnicity, or gender, type of clinical problem)
ʿI—intervention (the types of clinical intervention)
ʿC—comparison (a comparison of interventions)
ʿO—outcome (the type of patient care outcome)
Over the years, others modified the acronym to be PICOT, where the T means time. The time variable is not required, though. Some use the acronym as PICOTT where the TT means type of study and type of question (UNC Health Science Library, 2016, November 30).
You can use the PICO process to answer clinical questions that have no definitive answers. You can use the process to explore knowledge gaps in care practices. The PICO process serves as a foundation for many translational research studies. For example, what is the best way to treat otitis media in children under the age of 5? How do symptoms of angina compare between women and men after the age of 65? Write out the PICO question.
Map the terms used in the PICO question with terms used in the library database. Ask a librarian for assistance as needed, because there are differences in search terminology for individual databases. Avoid using medical abbreviations and acronyms, such as PICC line or PEG, to avoid limiting searches. Computer databases are not able to make interpretations about the meaning of abbreviation, so always write out the meaning.
MEDLINE/PubMed, sponsored by the National Library of Medicine, is available at no charge from any computer with an Internet connection. You can search MEDLINE/PubMed using the PICO tool at http://pubmedhh.nlm.nih.gov/nlmd/pico/piconew.php (Figure 9-1). Yensen (2013) described using the MEDLINE/PubMed PICO search engine in an article for the Online Journal of Nursing Informatics (OJNI) at http://ojni.org/issues/?p=2860. The article includes screenshots and visuals on how to use the PICO search tool. The PICO search engine allows you to select a research study type, which is a level of evidence. There are seven levels of research evidence (Melnyk & Fineout-Overholt, 2014). Figure 9-2 collapses the seven levels into five, where expert opinion is the lowest level and systematic reviews (and meta-analyses) are the highest level of research evidence. Systematic reviews involve a critical analysis of a grouping of research studies addressing a specific research question to inform healthcare decision making (Horsley et al., 2011, August 10). The systematic methods used minimize bias of the reviews. The Cochrane Library (http://www.thecochranelibrary.com) is the gold standard when searching for systematic reviews that support EBP.
MEDLINE/PubMed PICO search tool. (Reprinted from National Library of Medicine.)
Notice that the levels of evidence in the MEDLINE/PubMed PICO search tool are not in order according to levels of evidence. There are several excellent tutorials for understanding the PICO search tool. For example, PICO: Formulate an Answer at http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e84.php and PICO Questions: A Tutorial at http://libguides.uwyo.edu/PICOTtutorial.