Term 2: PICOT Model for Asking Clinical Questions
Nurs 1261 class - July 18, 2014
Use the PICOT Worksheet to sketch out:
- P-I-C-O-T elements for your topic: Population, Intervention/issue and Outcome
Comparison and Time may not be required, depending on your topic
- Question type: Is it an intervention, etiology, diagnosis, prognosis, or meaning question?
See more details and examples on the worksheet.
Follow-up PICOT tips & examples (from PowerPoint slides):
The PICOT model helps you to develop a specific clinical research question. With this focus, when you search you'll find targeted results and not waste time on irrelevant material.
P, I, and O components must be present.
C and T may or may not be present, depending on the question.
- Patient population
Describe a group of patients similar to yours. Use factors such as: age group, gender, ethnicity, having a disease or condition.
Example: overweight adult with hypertension
- Intervention or issue of interest
Describe the intervention you are considering, such as a treatment or diagnostic test.
Example: diet and lifestyle changes
If appropriate, identify the main alternative treatment for comparison.
Example: no change in diet or exercise
Describe the desired effect or outcome for the patient.
Example: weight loss and reduction in blood pressure
The outcome MUST be measureable. For example, "feeling better" would not be a measurable outcome.
If a specific time period is relevant for your question, note the period over which population is observed or outcome is measured. Note that many PICO questions do not include time.
Example: within three months
Resulting PICOT question:
In overweight adults with hypertention, does changing diet and exercise result in weight loss and reduced blood pressure within a three month time period?
See this example demonstrated:
Evidence-Based Practice: What it is and What it is Not (streaming video, 20 min)
- shows a student developing this actual PICO question based on her clinical experience
- PICO discussion starts at 8:22 min
What is evidence based practice?
“… a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.” (Stillwell et. al., 2010)
How does PICOT fit into the Research part of EBP?
As evidence based practice evolved in health professions (including nursing) in the late 1990s and early 2000s, PICO (and later PICOT) was developed as the standard way to ask structured, focused, answerable clinical questions. Key words and concepts from the PICOT question could then be used to search nursing and biomedical literature for the best current evidence.
In 7 steps, here's how to work PICOT into the EBP research process:
There are 5 common types of clinical questions:
|Intervention||What therapy or treatment has the best outcome?|
|Etiology||What are the greatest risk factors or causes?|
|Prognosis||What is the course/likely complications of a condition?|
|Diagnosis||What test is most accurate and precise?|
|Meaning||What is the meaning of an experience for an individual or group?|
Health professionals have created PICOT templates for different types of clinical questions.
Here's a template for a PICOT 'Intervention' question.
In ______(P), how does ______(I) compared with ______(C) affect ______ (O) over ____ (T period of time)?
Templates for these 5 types of PICOT questions are provided on page 60 of this article:
In Stillwell, S., et. al. (2010). Asking the clinical question: a key step in evidence-based practice. American Journal of Nursing, 110(3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79
You can also Google PICOT question template to find examples on the Web.
General sources provide information to answer more broad, general questions such as pathophysiology, diagnosis, therapies, prevention, etc.
In addition to your textbooks, here are sources to consult that are geared to health professionals, rather than to consumers.
- Merck Manual of Diagnosis and Therapy
Free online version of the well-known medical textbook.
Sample article: Deep Venous Thrombosis
Sample section (with many sub-topics): Care of the surgical patient
- e-CPS (Langara license allows 5 simultaneous users)
Online version of the Compendium of Pharmaceuticals and Specialties, with web access to the most current Canadian drug information available. From the Canadian Pharmacists Association (CPhA).
Sample CPhA drug monograph: ACE inhibitors
At this point, you can write out a working PICOT question, by filling in a template based on your clinical observations and the background information you've researched.
You still may not know:
- if there is enough evidence to answer your clinical question as it is stated
- what specific, measurable outcome is the best one to use
- whether you need to narrow or broaden your population any further
- whether you should modify/change your intervention or comparison
The next step is to search Medline and/or CINAHL to answer those questions, so you can develop your final (answerable!) PICOT question.
Some ideas for starting your search:
- List your P, I, C, O, and T terms
You may not have any C or T terms, and you might not know your O yet
- Write down a search that uses ‘AND' to combine your P and I terms
e.g. overweight adult AND lifestyle changes
- If needed, feel free to try different P and I terms
e.g. overweight adult* AND diet
adult* will search for adult, adults, adulthood, etc.
Searching in CINAHL & Medline:
- If keyword searches are not working, try to find Subject headings for your topic
- For clinical topics, limit searches to results within the last 5 years
- Plan to search both CINAHL and Medline in order to cover all possible journals of interest