Going in the “Write” DirectionAmy Curry, MS, CCLS – Texas Children’s Hospital

Lindsay Heering, CCLS, CTRS – Children’s Hospital of MichiganJennifer Fieten, MA, CCLS

Evidence Based Practice Committee – Child Life Council

How do PICO questions fit within evidence-based practice?

What are PICO questions?

There are five steps in evidence-based practice: 1. Ask the question2. Search the evidence3. Analyze the evidence4. Apply the evidence to practice 5. Evaluate the evidence

The PICO method assists the professional in creating a well-defined question to effectively search the evidence to answer the practice question.

A method for creating a clearly defined, searchable, answerable question to help effectively search for evidence. PICO is an acronym that comes from the components of the question:

P: Patient characteristics/Population of interest I : Intervention of interest C: Comparison intervention of interest O: Outcome of interest

PICO questions lead you to precise and high quality evidence. They are vital to implementing evidence-based decisions.

In (population of interest)Is (intervention of interest)

Better than (comparison of interest)At (outcome of interest)?

ReferencesCochrane Reviewer’s Handbook (2003). Section 4: Formulating the problem. Found at http://www.cochrane.dk/cochrane/handbook/hbook.htm. Accessed February 8, 2009.Counsell, C. (1997). Formulating questions and locating primary studies for inclusion in systematic reviews. Annals

of Internal Medicine, 127, 380-387. Melnyk, B. & Fineout-Overholt, E. (2005) Evidence-Based Practice in Nursing and Healthcare. Philadelphia: Lippincott, Williams & Wilkins.Miller, S. (2001). PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research.Stone, P. (2002). Popping the (PICO) question in research and evidence-based practice. Applied Nursing Research, 16, 197-198.Stratus, S. & Sackett, D. (1998) Getting research findings into practice: Using research findings in clinical

practice. British Medical Journal, 317, 339-342.

How can PICO questions fit within research projects and setting?

Evidence-based practice relies on research for evidence, and evidence-based practice can point to gaps in the research that need investigation. When developing the literature search for the research project, the PICO method can be used to locate an increased number or better quality of results.

Population or Patient Characteristics

The patient population or disease of interest:• Illness/diagnosis/injury • Chief complaint/main symptom• Behavior• Age • Gender• Ethnicity • Other factors

Intervention The intervention of interest:• Intervention A (i.e. preparation, oral sucrose, non-pharmacological pain management)• Procedure • Treatment or medication • Having a disease

Comparison Intervention

The comparison intervention of interest:• Intervention B • No intervention (i.e. standard care)• Placebo• No disease• Single method versus a combined approach (i.e. “A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children”)

A comparison intervention may not be necessary for all questions.

Outcome The outcome or goal being measured:• Pain scores• Anxiety level (i.e. heart rate/blood pressure)• Understanding of disease

Applying PICO Questions to Child Life

Accessing Evidence: Utilize Your Resources

1. Use your medical library:• A medical librarian can save you time by searching multiple

sources for information • Request your medical librarian to in-service your

department 2. Use the Internet: many databases are available online

Patient/Population: InfantsIntervention: NICUComparison Intervention:

Not being in NICU (no comparison)

Outcome: AttachmentWrite your question: In infants, what is the

effect of being in the NICU on attachment compared with not being in the NICU?

P: Infants, neonates, newborn, pre-matureI: NICU, neonatal intensive care unitC: (no comparison)O: Attachment, parental bonding, parent-

child interaction

Human, English language, no time limits

PubMed, CINAHL, Cochran, PsycInfo, Scopus

Searching the evidence using a PICO question

1. Determine the search terms from the PICO question2. Identify alternatives/synonyms for search terms3. Select the databases that will contain the information that you

want to find 4. Enter search terms and alternative search terms in databases to find relevant materials

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2. Identify the type(s) of study to include in your search: (check all that apply) ✓ Systematic review ✓ Cross-sectional study

✓ Meta-analysis ✓ Review of qualitative studies

✓ Quantitative study ✓ Randomized control trials

✓ Qualitative study ✓ Controlled trial without randomization

✓ Case control ✓ Expert opinions

✓ Cohort ✓ Textbooks, non-EBP guidelines

3. List alternative search terms for the various parts of your PICO question:

1. Develop your PICO question: A PICO question will help you determine your search strategy.

4. Define limits for your search:

5. List the databases you intend to search:

PICO Question Worksheet