Evidence-Based Practice: Ask the Question

One of the basic skills required for practicing EBP is developing a well-built clinical question. Theses questions need to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for relevant and precise answers. PICO makes this process easier. It is an acronym/mnemonic for the important elements of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.

PICO or PICOTT:

P = PATIENT OR PROBLEM - How would you describe a group of patients similar to yours?  What are the most important characteristics of the patient?

I =  INTERVENTION, EXPOSURE, PROGNOSTIC FACTOR - What main intervention are you considering?  What do you want to do with this patient?

C =  COMPARISON - What is the main alternative being considered, if any?

O =  OUTCOME - Include patient oriented outcomes (morbidity, mortality, quality of life, etc).

Type of Question - Identify the question scenario:

• Therapy / Diagnosis / Etiology / Prognosis

Type of Study - Identify study design to help answer question:

• Systematic review / RCT / cohort study / case controlled

Primary Question Types

• Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
• Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
• Prognosis: how to estimate a patient's likely clinical course over time due to factors other than interventions
• Harm / Etiology: how to identify causes for disease (including its iatrogenic forms).

Other Question Types

• Clinical findings: how to properly gather and interpret findings from the history and physical examination.
• Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
• Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
• Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
• Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.

From: Sackett, DL. Evidence-based medicine: how to practice and teach EBM.