NUR 440 Final Project Milestone Two: PICO(T) Guidelines Paper.

In Milestone One, you submitted a topic proposal for instructor approval and feedback. For Milestone PICO(T) Guidelines and Rubric Overview Two, you will incorporate any feedback and formulate a PICO(T) question which will guide your research for the integrative review of the literature. Your PICO(T) question will assist you in the process of finding and evaluating evidence related to your outcome as you continue to build upon your final project. Prompt: For this PICO(T) Guidelines and Rubric Overview milestone, you will turn your topic into a PICO(T) question by answering each of the questions posed below: ? Identify the population of interest; what are their characteristics? Specifically, what group of individuals will be impacted by your identified intervention? ? What is the intervention of interest? (Intervention) ? What is the comparison intervention? (Comparison) ? What consequences are we interested in? (Outcome) ? What is the time frame? If a specified time frame is not appropriate for your question, please articulate why a time frame is not applicable. For examples of PICO(T), refer to your module resources. Guidelines for Submission: Your PICO(T) question must be submitted as a 1–2 paragraph Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and any sources cited in APA format PICO(T) Guidelines and Rubric Overview

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Template for Asking PICOT Questions

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Prevention:

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Prognosis/Predictions

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

Meaning

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.

Develop your Research Question

The PICO(T) Question

A clinical question that is composed using the PICO or PICOT format will help you to focus your search and help you to develop your research skills which are essential in finding the best available evidence.

The most common PICO(T) elements are:

P – Population

How you would describe a group of people with a similar problem or complaint.

I – Intervention

How you plan to treat, medicate, diagnose and/or observe the patient’s care.

C – Comparison (if applicable)

The main intervention alternative you are considering (i.e. placebo, alternative therapy, different drug, surgery).

O – Outcome

The result from proposed treatment that is measurable, including improvement of symptoms,no symptoms, or complications.

(T) – Time (if applicable)

The time frame of treatment and/or measurable outcome.

PICO(T)

In order be successful in using Evidence Based Practice (EBP) you will need to learn how to develop well-composed clinical questions. By formatting your research question in a PICO(T) format you can gather evidence relevant to your patient’s problem. Well-composed PICO(T) questions generally contain up to four components each represented in the acronym “PICO(T)” P=Patient or Population and Problem; I=Intervention or Indicator; C=Comparison or Control (not part of all questions); O=Outcome; T=Time or Type.

 

MORE INFO 

Formulating a PICO(T) question in research

Introduction

A clinical question is a question that can be answered using evidence from systematic reviews. This means it’s possible to answer your question without doing a study. A good clinical question will help you decide if there’s enough evidence to support your recommendation or treatment plan, but it also helps you focus on the research topic in ways that are meaningful for you as a clinician or researcher. The PICO(T) model is one way we use to think about how to formulate these questions.

The PICO(T) model is a mnemonic used to describe the four elements of a good clinical question.

The PICO(T) model is a mnemonic used to describe the four elements of a good clinical question. The first three elements are patient or problem, intervention and comparator. The fourth element of the acronym is time (or type) of study.

The PICO(T) model can help you think about how you should formulate your research questions if you want to answer them with valid data collection techniques.

It also helps us think about how to focus the question for a systematic review.

A PICO question helps you focus on the patient problem, intervention, comparator and outcome. In other words, it helps us think about how to focus our review:

• What is it that we are trying to find out? For example, we may be interested in knowing if patients who undergo a particular surgery have better outcomes than those who don’t. Or perhaps we want to see if patients who receive treatment for depression have better outcomes than those who don’t.

• What interventions are available for this problem? For example, do some treatments work better than others? Are there different types of treatments (e.g., medication vs therapy) or combinations of these things that work best together when treating this condition?

• What comparisons can we make between different interventions or combinations thereof on our topic area as part of our systematic review strategy? For example – does one type of medication work better than another type at controlling symptoms related specifically with depression; does one type work differently from another when administered during pregnancy so as not interfere with fetal development; etc…

The acronym stands for P atient or P roblem, I ntervention, C omparator, O utcome.

The acronym PICO stands for:

Patient/Problem, Intervention, Comparison and Outcome.

The P in this case refers to the patient or subject of study. A patient is a person who has been diagnosed with a disease or condition. In research studies involving humans, it can be helpful to select patients that are representative of your target population (i.e., they match your study’s demographics). For example if you were studying how people with high cholesterol are affected by statins then you would want to include those who have had their cholesterol checked at least once during the past year on your sample population so that there is no bias toward healthier individuals who may not need statins while also having low risk factors present in their lives such as eating right and exercising regularly; these factors may not necessarily apply equally across all groups but rather specific subgroups within each group based on age range etcetera which will affect treatment outcomes differently depending upon whether someone starts taking medication immediately after diagnosis vs later down road after experiencing symptoms first hand before seeing doctor about it being necessary due to certain conditions affecting health status overall thereby warranting intervention early instead waiting until later stages when symptoms become more serious causing intervention sooner rather than later due lack thereof thus resulting from delayed treatment option due lack thereof availability options available during initial stages prior diagnosis stage which could lead us into making wrong decisions about treatment plans leading us down wrong path towards wrong conclusion about what needs done next instead take advantage opportunity given us now instead fall victim again another fail attempt because we weren’t prepared enough either way

The fourth element of the acronym is T ime or type of study.

The fourth element of the acronym is T ime or type of study. The time element of PICO(T) can be used to help filter a systematic review search strategy, and it can also be used to help identify relevant studies for inclusion in a systematic review.

An example might be: In patients with Stage IIIB non-small cell lung cancer (NSCLC), does adjuvant chemotherapy compared with observation improve survival?

The question above is an example of a PICO(T) question. It asks, “In patients with Stage IIIB non-small cell lung cancer (NSCLC), does adjuvant chemotherapy compared with observation improve survival?”

The answer to this question may be yes, but it also might be no or another answer such as: “We don’t know yet.” The answer can have significant implications for clinicians and patients because it opens up opportunities for further research in this area.

For this particular example, the patient problem would be Stage IIIB non-small cell lung cancer;

For this particular example, the patient problem would be Stage IIIB non-small cell lung cancer; however, any other type of patient problem could work in this example.

The first step is to determine if your research question is relevant to patients with this disease. If it isn’t, then you should ask yourself why? Is it because no one cares about stage IIIB non-small cell lung cancer? Or are there just too many variables (such as age, gender and ethnicity) that make it impossible for doctors to find patterns within their data? In either case—if your study has any chance at all at answering these questions—you need relevant information from real people who have already been through what you are studying.

the intervention of interest would be adjuvant chemotherapy;

The intervention of interest would be adjuvant chemotherapy. The comparator would be observation. The outcome would be survival.

the comparator would be observation; and the outcome would be survival.

In this example, the comparator would be observation; and the outcome would be survival.

The comparator should be a treatment that is accepted as standard of care in your area or country. You can use this information to help you choose your comparators: they should be similar to the intervention being studied, but not identical (i.e., if you are studying an antibiotic for pneumonia and want to compare it with another antibiotic). If possible, look online for clinical trials comparing both treatments at once so you have more data available to evaluate their effectiveness against one another.

The PICO(T) model can help you create a focused clinical question and systematic review search strategy.

The PICO(T) model is a mnemonic for describing the four elements of a good clinical question:

• patient population (or “who”)

• intervention (or “what”)

• comparison group(s), if any, and their characteristics and outcomes. This includes their indication for use, dose or frequency of administration, known side effects etc.

• outcome of interest – whether it’s symptom relief or improvement in other aspects of health such as mobility/functionality/quality-of life

Conclusion

PICO(T) is a powerful tool for creating focused clinical research questions and systematic review search strategies. It has been used in many fields of medicine, but it’s especially useful when developing PICOs for oncology trials that seek to answer why-questions about the effectiveness or harms of treatments.