Developing a clinical question, PICO and Resources

patient, population, problem

• P in PICO

intervention (variable)

• I in PICO

Comparison

• C in PICO

outcome

• O in PICO

why is PICO used

• to formulate a concise clinical question for a clinical problem/ situation requiring an evidence based answer

consideratons for patient/population/problem

• age

• condition

• disease

• ethnicity

• gender

consideration for intervention

• diagnostic test

• drug

• therapy

• is it realistic (available, cost, conventional)

• is it any different from current practice?

consideration for comparison

• alternative to the intervention

• different medication or diagnostic test

• no treatment

• placebo

considerations in outcome

• what do you aim to achieve/measure

• relevance to patients: improvement in symptoms/QOL, reduction in adverse events?

other PICO factors

• study design: RCTs, cohort studies, case-controlled studies, cross-section studies, systematic reviews, meta analysis

• time- time frame for the outcome, study duration, follow up period

PICO format

• for a population with a specific condition, does an intervention compared to a comparison, result in a better outcome

evidence cycle

• assess your patient

• ask clinical questions

• acquire the best evidence

• appraise the evidence

• apply evidence to patient care

assess

• determine relevant issues by assessing the patient and the problem

• consider- diagnostic techniques, prognosis, and therapy options

ask

• use PICO to formulate a concise clinical question to be asked

acquire

• use appropriate resources to acquire evidence

• consider- pros and cons of each type of medical literature

appraise

• critical appraise the acquired evidence

• consider- compartibility, reliability, validity, and applicability to the clinical question by assessing methodology, relevance, and results of retrieved studies

apply

• ___the evidence can lead to beneficial practical interventions and changes in the clinical practice

• informed clinical decisions are made from the integration of the appraised evidence, clinical expertise, and patient values and preferences