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Evidence-Based Practice (EBP)

In addition to the basics of EBP and PICO, this guide answers questions about primary vs. secondary sources, where to look for evidence, and how to search to get the best results.

The PICO(T) Chart

When searching for evidence-based practice studies in the Nursing and Medical databases, you must first develop a well-built clinical question. Below is a chart to guide you in formulating a question by breaking it down to its most important parts.

Students sometimes have difficulty incorporating classroom skills into the clinical setting. The PICO(T) Chart provides an easy framework for integrating clinical information into the development of a research question. Students can complete the following worksheet, incorporating detailed information into each response.

Decide what your research interest or topic is and then develop a research question to answer it.

PICO(T) Your PICO(T) Elements ⇒ Search Terms
P

POPULATION / PATIENT / PROBLEM
Consider:

  • What is the patient population or primary problem?
  • What are the relevant demographic factors or most important characteristics of the patient?
  • What is the setting?
                                                                                                                                                                                                                  
I

INTERVENTION
Consider:

  • What is the main intervention, treatment, diagnostic test, procedure, exposure, patient perception, or risk factor?
  • What are the dosage, frequency, duration, and mode of delivery?
  
C

COMPARISON / CONTROL (optional)
Consider:

  • Is there an alternative intervention or treatment to compare? 
    • Active: a different drug, dose, or kind of therapy
    • Inactive: placebo, standard care, no treatment
  
O

OUTCOME (optional)
Consider:

  • What is(are) the ideal clinical outcome(s)?
    • It should be specific and measurable
    • It can be objective or subjective
  
T

TIME (optional)
Consider:

  • How much time does it take to demonstrate the clinical outcome(s)?
  

Design a question that incorporates the most salient piece of information from each of the above categories.

My literature search question is:                                                                                                                                                              


 

PICO Template Questions

The PICO framework is ideal for building questions that focus on comparing treatments. Other types of questions—especially those focused on prognosis, etiology, or perceptions—can be more challenging. Just remember that the Intervention portion usually represents the piece of your research you're interested in comparing or controlling; if you were designing an experiment, it would be the piece that you manipulate to see what results you'd get. 

Asking Different Types of Questions
Question Type Patient/Problem Intervention/Exposure Comparison/Control Outcome
Treatment (therapy) Patient's disease or condition Therapeutic measure (e.g., a medication, surgical intervention, lifestyle change) Standard of care, another intervention, or placebo Mortality rate, days absent from work, pain, disability
Prevention Patient's risk factors and general health condition Preventive measure (e.g., a medication, lifestyle change) May not be applicable Disease incidence, mortality rate, days absent from work
Diagnosis Target disease or condition Diagnostic test or procedure Current "gold standard" test for the condition Measures of the test utility (i.e., sensitivity, specificity, odds ratio)
Prognosis (natural history) Main prognostic factor or clinical problem, in terms of its severity and duration Exposure of interest is usually time (sometimes expressed as "watchful waiting") Usually not applicable; if your question is about "watchful waiting," identify standard treatment Survival rates, mortality rates, rates of disease progression
Etiology or harm (causation) Patient's risk factors, current health disorders, or general health condition Intervention or exposure of interest, including some indication of the strength (dose) of risk factor and the duration of exposure May not be applicable Disease incidence, rates of disease progression, mortality rates


You may find it helpful to use one of the following templates when creating your PICO question. Remember, the time (T) piece is usually optional and therefore can be omitted.


Treatment (therapy) — questions addressing the treatment of an illness or disability:

In _______(P), how does _______(I) compared with _______(C) affect _______(O) within _______(T)?

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

Ex 1: In African American female adolescents with hepatitis B (P), how does acetaminophen (I) affect liver function (O) compared with ibuprofen (C)?
Ex 2: In inpatient chronic schizophrenia patients (P), do social skills group training sessions (I) increase conversational skills (O) when compared with standard care (C)?

Prevention — questions addressing the prevention of a risk factor or problematic health condition:

In _______(P), does the use of _______(I) reduce the incidence [or future risk] of _______(O) compared with _______(C)?

Ex: In adult females (P), do daily vitamin C or zinc supplements (I) reduce the incidence of the common cold (O) compared with no intervention (C)?
 

Diagnosis — questions addressing the process of determining the nature and cause of a disease or injury through evaluation:

In _______(P) is/are _______(I) more accurate in diagnosing _______(O) compared with _______(C)?

Ex: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) more accurate in diagnosing an acute myocardial infarction (O) compared with one initial 12-lead ECG (C)?
 

Prognosis (natural history) — questions addressing the prediction of the course of a disease:

In _______(P) how does _______(I) compared with _______(C) influence _______(O) over/during _______(T)?

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

Ex 1: In patients 65 years and older (P), how does the use of an influenza vaccine (I) compared with not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?
Ex 2: In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared with being a non-smoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)?
 

Etiology or harm (causation) — questions addressing the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder:

Are _______(P) who have _______(I) at increased/decreased risk of _______(O) compared with those who have/do not have _______(C) over/during _______(T)?

Ex: Are 30- to 50-year-old women (P) who have high blood pressure (I) at increased risk for an acute myocardial infarction (O) compared with those without high blood pressure (C) during the first year after hysterectomy (T)?


Meaning or quality of life — questions addressing how one experiences a phenomenon:

How do _______(P) diagnosed with _______(I) perceive _______(O) compared with _______(C) during/over _______(T)?

Ex 1: How do young males (P) diagnosed with below-the-waist paralysis (I) perceive their interactions with their romantic partners (O) during the first year after their diagnosis (T)?
Ex 2: How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels to their healthcare providers (O) during their pregnancy and six weeks postpartum (T)?

Adapted from the PICOT Question Template, Ellen Fineout-Overholt, 2006. This form may be used for educational and research purposes without permission.