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Nursing

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PICO and other question frameworks

Why use a question framework?

Formulating an answerable question is not as easy as it sounds. Clinical questions are often wide-ranging and complex and it can be very challenging to effectively translate a clinical question so that it can be answered from the literature.

Question frameworks such as PICO are designed to make answerable questions easier which in turn makes it easier to:

  • find the information required to answer the question
  • identify keywords within the question for search purposes
  • build and refine the search approach
  • ensure that the evidence you search for is logically related to the question

 

PICO

PICO is an acronym used to formulate research questions and guide the search for relevant evidence.

It includes:

• Patient/Population: Describes the group of individuals or patients being studied.

• Intervention: Specifies the treatment or intervention being considered.

• Comparison: Refers to an alternative treatment or control group.

• Outcome: Identifies the expected result or outcome of the study.

 


Limitations of PICO

The PICO framework is most suitable for clinical and intervention-based research questions. It may not be appropriate for all types of research and an alternative question framework might be better suited. 

P - Patient, Population or Problem

Patient Characteristics: Define the specific characteristics of the patient or population of interest. Consider aspects such as age, gender, ethnicity, socioeconomic status, and any relevant demographics.
Clinical Condition: Describe the clinical problem or condition in detail. This includes the primary diagnosis or health issue, symptoms, severity, and any relevant medical history.
Context: Specify the setting or environment where the patient population is encountered (e.g., hospital, community clinic, outpatient setting).

Example of PICO Element Focus (P):
In elderly patients (age 65 and older) admitted to acute care hospitals (P), does early mobilization (I) compared to standard care (C) reduce the incidence of hospital-acquired infections (O)

 

I - Intervention

What is the main intervention or exposure being considered?
Describe the specific treatment, therapy, diagnostic test, preventive measure, or other intervention under investigation.
Specify the details of how the intervention will be administered or applied.


Example of PICO Element Focus (I):
In patients with type 2 diabetes (P), does a low-carbohydrate diet (I) compared to a standard diet (C) result in better glycemic control (O)

 

C - Comparison

What alternative intervention, exposure, or control group will you compare with the main intervention?
Specify the comparator, which could be another treatment, placebo, standard care, or no intervention.
Describe how the comparison group differs from the intervention group.


Example of PICO Element Focus (C):

In patients with hypertension (P), does treatment with ACE inhibitors (I) compared to beta-blockers (C) reduce the risk of cardiovascular events (O) over a five-year period (T)?

 

O - Outcome

What specific outcome(s) are you interested in measuring or achieving?
Define the desired effect or result of the intervention or exposure being studied.
Specify the measurable endpoints that will indicate the impact of the intervention.


Example of PICO Element Focus (O):

In pregnant women with gestational diabetes (P), how does dietary counseling (I) compared to insulin therapy (C) affect birth weight (primary outcome) and maternal glycemic control (secondary outcome) (O)

 

PCC

• Population/Participants: What is the population of interest including any important characteristics

• Concept: What is the concept being examined?

• Context: Are the specific settings or important factors?
 

P - Population - Participants

Who is the focus of the study? (e.g., age group, gender, specific condition)

Are there any specific characteristics that define this population? (e.g., demographic factors, clinical features)

Should certain subgroups be included or excluded within this population?

Example:
 

  • Who: Adults aged 18 and older diagnosed with diabetes (both Type 1 and Type 2).
  • Specific Characteristics: Includes both male and female patients, with no restrictions on ethnicity or socioeconomic status.
  • Subgroups: May include subgroups based on the severity of diabetes, presence of comorbidities, or duration of diagnosis.

 

C - Concept

What is the main idea or phenomenon I am investigating?

Are there specific aspects or dimensions of this concept that I need to focus on?

What are the key terms or keywords associated with this concept?


Example:

  • What: The effectiveness of telehealth interventions.
  • Aspects: Includes various types of telehealth interventions such as remote monitoring, virtual consultations, and tele-education.
  • Key Terms: Telehealth, telemedicine, remote monitoring, virtual consultations, diabetes management.

 

C - Context

Where is the study taking place? (e.g., geographical location, type of institution)

Under what conditions or settings is the concept being studied? (e.g., cultural, social, economic)

Are there any specific factors in the context that might influence the population or concept?


Example:

  • Where: Studies conducted in various settings, including urban and rural areas, hospitals, clinics, and home-based care.
  • Conditions: Focus on interventions implemented in high-income countries with established telehealth infrastructure.
  • Specific Factors: Consideration of factors such as access to technology, patient engagement, and healthcare provider support.

 

Resulting question

"What is the effectiveness of telehealth interventions in managing diabetes among adults aged 18 and older, considering various types of telehealth services such as remote monitoring, virtual consultations, and tele-education, in high-income countries with established telehealth infrastructure?"

 

SPIDER

Sample - Who is the sample or population of interest?
Phenomenon of Interest - What do you hope to understand? Beliefs, attitudes, behaviours, experiences?
Design - What types of study methods are you interested in? Survey, interview, focus group?
Evaluation - What are the evaluation outcomes? These may be subjective such as feelings, attitudes, opinions etc.
Research Type - What type of research best suits your question? Qualitative, quantitative or mixed methods?

PEO

Population / Patient / Problem - Who is the question focused on? What are the characteristics?
Exposure - What is the issue of interest? Condition, illness, risk factor?
Outcomes - What are the outcomes or themes of interest? What is the impact of the exposure on the population?

SPICE

Setting - What is the location or setting?
Perspective - Whose perspective is of interest? Who is the group being studies?
Intervention - What is the treatment, intervention, strategy or test?
Comparison - Compared with what? Is there an alternative?
Evaluation - With what result? What are the outcome measures?

ECLIPSE

Expectation: What are the expectations or outcomes that the research aims to address?
Client group: Who are the primary recipients or beneficiaries of the service or intervention?
Location: Where is the service or intervention being provided?
Impact: What is the impact or effect of the service or intervention?
Professionals: Which professionals are involved in delivering the service or intervention?
Service: What specific service or intervention is being evaluated?
Evaluation: How will the service or intervention be evaluated?


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