ANALYZING CLINICAL QUESTIONS Turning Your PICO into a search strategy Shelly Warwick, MLS, Ph.D. 2013 – Permission is granted to reproduce and edit this work for non-commercial educational use as long as attribution is provided and the edited work is also available under the same terms of license.

After This Unit You Should be Able to: State what does PICO and PICO(TT) stand for? Explain how a PICO helps you create a search strategy? Develop a PICO statement Develop a search strategy to answer the question posed by the PICO

What is a “good” question ? The key components of a good clinical question are: Patient/Population/Problem Intervention/Exposure Comparison Outcome How do we look for answers? Selecting the key components of a good question will help you develop an efficient and effective search strategy Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12 Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

The Well-Built Question: “P.I.C.O.” Model Patient/Population/Problem ( Among….) Intervention/Exposure ( does….) Comparison (versus….) Outcomes ( affect…) Example: Among pre-menopausal, minority women with hypertension living in New York City, does a program of regular exercise versus no regular exercise have a measurable affect in reducing hypertension? Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12 Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

Structure of a focused question, 1: Patient/Population/Problem: Demographic characteristics (age, gender, etc.) Disease or condition Stage, Severity Intervention: Type of intervention or exposure: Exposure to a risk factor New Diagnostic test Treatment Health care services, management strategies Dose, duration, timing, route, etc. Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12 Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

Structure of a focused question, 2: Comparison: Another risk factor (or the absence of), a current standard of care, a new type of treatment/intervention, an alternative therapy, placebo, or no intervention at all Outcome: Defined and measurable - test result or physiological number Risk or protective Impacts mortality, morbidity, quality of life, etc. Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12 Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

PICO + What type of question are you asking and what is the best study design to answer it?

Limits of PICO (TT) model This model works best for Therapy/Treatment & Diagnosis questions. Remember: PICO (TT) is a model, not a rigid structure.

Think Synonyms While some conditions or interventions can be described with a single well-recognized term others cannot, or you can improve your search results by using more terms. Such as: “Learning OR Cognition” “Diet or nutrition”

Exercise – Translate Clinical Scenario into PICO format On morning rounds in the Hematology/Oncology unit, s patient says she wants to discuss options for managing moderate nausea and vomiting that result following her chemotherapy. She shares an experience a relative had taking ginger when Prochlorperazine didn’t provide effective relief and asks for your input.

PICO Breakdown of Question Patient/Population/Problem = chemotherapy patients/experiencing adverse effects of nausea & vomiting Intervention/Exposure = Ginger Comparison = Prochlorperazine Outcomes = relief/reduction of nausea & vomiting due to chemotherapy

Search Strategy Terms Possible Search Terms: Ginger Prochlorperazine (Class = Antiemetics) Chemotherapy (Chemotherapy, Adjuvant) nausea and/or vomiting, reduced incidence