After first identifying an information need, the next step in evidence-based practice is to re-frame the problem by posing a clearly stated and searchable question. EBP practitioners use a structure called PICO to advance their thoughts from fuzzy and generalized to crisp and precise.
PICO is a framework for structuring a clinical question by separating it into four components. Framing PICO helps you identify some of the keywords you will use in searching databases.
P = What are the significant characteristics of the patient or the population?
I = What intervention are you considering?
C = Are you considering another intervention as a comparison to the first?
O = What is the desired outcome of the intervention(s)?
(Time is sometimes a fifth element of PICO.)
(T) = How much time does it take for an intervention to reach an outcome?
Need a few good examples of PICO in action to get you started? The following websites take you through short, easy-to-follow examples on how to formulate good research questions using the PICO framework of Patient, Intervention, Comparison, and Outcomes:
Adapted from John Moritiz Library's EBP LibGuide.
Gee, wouldn't it be nice if they made a search tool that allowed you to just input your PICO framework directly into the search box?
Guess what--they have! Trip Database is a clinical search engine designed to allow users to find high-quality, evidence-based research to support their practice and/or care.* Just be aware that when you search with your exact PICO framework, you will find a case study. The PICO framework is NOT designed to be a clinical research topic! (See PART 1 on this page for more information on turning PICO into a clinical topic.)
To activate the PICO search tool, click on "PICO search" on the Trip Database website:
*Here's what Trip Database says about itself: "The Trip search system has an unrivaled collection of high-quality secondary evidence ranging from systematic reviews and clinical guidelines to evidence-based synopses and clinical Q&As. This is supplemented with a substantial collection of high-quality, health related, grey literature and other great content to support clinical decision making."
PAY CLOSE ATTENTION: You will need to turn your PICO framework into a clinical research topic.
Why? Although the PICO framework is an excellent framework to get at the root of a clinical problem, it is NOT a good format to search a database.
Why not? Let's look at this PICO example for a patient:
Are probiotics a more effective treatment for C --diff- associated diarrhea in a 45-year-old hospitalized male than x, y, z treatments?
You may be tempted to find search terms with using the exact PICO terms, like this:
Are probiotics (Intervention) a more effective treatment for C --diff- associated diarrhea in a 45-year-old hospitalized male (Patient) than x, y, z treatments (Comparison)? [What's the Outcome? In this case, the outcome is implied = a reduction in diarrhea.]
Unfortunately, searching for medical literature in a database isn't that specific. If so, you'd be looking only for a matching case study! Instead, you need to turn your PICO statement into a clinical research topic that you can search for. In this case, you clinical research topic is:
"Probiotics as a treatment for diarrhea caused by Clostridium difficile infections."
And your search terms might look like this:
Probiotics as a treatment for diarrhea caused by Clostridium difficile inflections.
Here are a few search tips to keep in mind successful database searching, with PICO elements for your search terms:
Partially adapted from John Moritiz Library's EBP LibGuide.