The Clinical Inquiry Process Resource Guide

The PICOT Format 

Once you have started to make your question one that is focused (foreground question), the next step is to take that question and break it into parts.  This can be done using the PICOT format.  This format will help in allowing you to more easily search for evidence on the topic as well as to better understand what needs to be known and the data that may be needed to measure the intervention. 

Remember that the PICOT format is not your question but just a way to break your question into components, enabling you to develop your search strategy. PICOT = Your Search Strategy

Tips for Writing a Clear Foreground Question:

Identify the Clinical Problem or Issue: Start by pinpointing a specific clinical problem or uncertainty in your practice. This could be related to patient care, treatment efficacy, or nursing interventions.

Define Each Component of PICOT:

• P (Population/Patient/Problem): Describe the patient group or problem. Consider factors like age, gender, medical condition, or setting.
• I (Intervention): Specify the treatment, procedure, or action you want to investigate.
• C (Comparison): Identify the alternative to the intervention, which could be another treatment, a placebo, or no intervention.
• O (Outcome): State the desired result or effect of the intervention. This should be specific and measurable.
• T (Time): (Optional) Include the duration over which the outcome will be measured.

Do not directionalize the outcome when writing a question. By placing a direction on an outcome, it will bias the search for evidence, resulting in an incomplete set of results from which to base an evidence-based decision.

Formulate the Question: Combine all elements into a clear, concise question. For example: “In elderly patients in long-term care facilities (P), how does implementing a daily exercise program (I) compared to standard care (C) affect the incidence of falls (O) over a six-month period (T)?”

Refine and Revise: Review your question to ensure it is focused, answerable, and relevant to your practice. Avoid being too broad or vague.

Common Mistakes to Avoid:

• Being Too Broad or Vague: Ensure your question is specific and focused.
• Including Multiple Interventions or Outcomes: Stick to one intervention and one outcome to maintain clarity.
• Using Terms That Are Difficult to Measure: Choose measurable and specific terms.
• Failing to Specify a Clear Comparison: Clearly define what you compare the intervention against when possible.

Additional Tips:

• Involve Stakeholders: Involve clinicians, patients, and other stakeholders in the development of the PICOT question to ensure its relevance and feasibility.
• Consult a Librarian or Methodologist: Consult with a librarian or methodologist for assistance in developing well-structured PICOT questions.
• Use a PICOT Template: Use a template to organize your thoughts and ensure all components of the PICOT question are included.

Question Definitions:

Intervention / Therapy: Questions about interventions, treatments, or strategies used to achieve specific outcomes.

In adult patients with stage 2 pressure ulcers (P), how does a structured repositioning protocol every 2 hours (I) compared to standard care (C) affect wound healing (O)?

Issue: Investigates problems, challenges, or concerns related to healthcare practices, policies, or systems.

In rural healthcare settings (P), how do best practices or strategies for telehealth implementation (I) compare to current implementation efforts (C) in mitigating barriers to patient care (O)?
 

Meaning: Explores subjective experiences, perceptions, and interpretations of individuals regarding health, illness, treatment, or healthcare experiences.

In cancer survivors (P), how does post-treatment status (I) influence their perception and interpretation of quality of life (O) after treatment (T)?

Prognosis / Prediction: Questions about likely outcomes, complications, or progression of conditions that inform care or treatment planning.

In post-stroke patients with dysphagia (P), how does early swallowing intervention (I) compared to standard care (C) influence pneumonia rates and recovery (O) over their hospital stay (T)?

Diagnosis: Questions about the accuracy or utility of assessment tools, screening methods, or diagnostic procedures.

In elderly hospitalized patients (P), is a nurse-led delirium screening tool (I) compared with physician assessment © more accurate in diagnosing delirium (O) within 24 hours of admission (T)?

Etiology: Questions about causes, risk factors, or harmful exposures relevant to a condition.

Are ICU staff (P), who have extended shift work (I) compared with those without extended shift work (C) at increased risk of medication error rates (O) over 6 months (T)?