1. Going in the “Write” Direction Amy Curry, MS, CCLS – Texas Children’s Hospital Lindsay Heering, CCLS, CTRS – Children’s Hospital of Michigan Jennifer Fieten, MA, CCLS Evidence Based Practice Committee – Child Life Council How do PICO questions fit within evidence-based practice? How do PICO questions fit within evidence-based practice? What are PICO questions? There are five steps in evidence-based practice: 1. Ask the question 2. Search the evidence 3. Analyze the evidence 4. 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)? References Cochrane 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? 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 InterventionThe 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. OutcomeThe 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 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: Infants Intervention: NICU Comparison Intervention: Not being in NICU (no comparison) Outcome: Attachment Write 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-mature I: NICU, neonatal intensive care unit C: (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 Searching the evidence using a PICO question 1. Determine the search terms from the PICO question 2. Identify alternatives/synonyms for search terms 3. 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 27 th Annual Conference on Professional Issues Boston, Massachusetts 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