When beginning with evidence-based practice, the first step is defining the problem you are trying to solve. This is how researchers develop proposals for what they want to study. In a clinical setting, you may use this process for quality improvement, encourage practices that are evidence-based, or to develop a research study.
Writing a Focused Clinical Question
PICO(T) is a mnemonic that helps us create focused and well-built clinical questions by breaking down the information that is needed to answer a research question.
P Patient or Population of interest / patient Problem
Who is/are the relevant patients? What are their demographics (age, sex, geographic location, important characteristics)? What is the key problem of the patient trying to be addressed? How would you describe the patients you are interested in?
I Intervention, Indicator, or Issue of interest, prognostic factor, exposure
What is the management strategy, diagnostic tests, or exposure being introduced or interested in? What main prognostic factor are you considering? What do you want to do for the patient? What test do you want to do or drug do you want to provide? What factors or exposures may affect the patient? Is the intervention a procedure, drug, test, questionnaire, time?
C Compare or Control of interest, alternative approaches to the problem or issue
What is the control or alternative management strategy? Are you looking at two different tests? A drug and a placebo? Intervention versus no intervention? Your question may not always have a specific comparison.
O Outcome, what is trying to be achieved
The patient-relevant consequences of the intervention. What you hope to achieve or accomplish or learn. For example, do you want to improve function, test scores? Patient-oriented outcomes.
T Time/Type of Question, Type of Study
What time periods should be considered? What is the study design/type used to answer the question? What types of questions are trying to be answered? Try to identify the question scenario. Is it a prospective study, double-blind, or other? What is the clinical area that your question aligns with?
Consider the type of question you are asking and the types of studies that could best answer it. When you have a well-focused question it is easier to determine the appropriate type of evidence needed.
For Example
In child patients with knee replacements (Population), how effective is pain medication (Intervention) compared to aerobic stretching (Comparison) in controlling post operative pain (Outcome) during the perioperative and recovery time (Time)?
Remember, evidence-based medicine always begins and ends with the patient, what can you do to support or help your patient?
