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Nursing Systematic Reviews: Is your PICO specific?

Created by Health Science Librarians

Case: Patient Education

  • You are a nurse working in a busy inpatient medical surgical unit. The patients on your unit are admitted for a wide variety of conditions: renal, GI, dermatologic, etc.
  • All patients admitted that are chronic smokers are given brief counseling by an RN and a self-help brochure about smoking cessation, but no follow up counseling after that.
  • You hear your coworkers complaining that they feel like they are wasting their time because they think the patients will resume smoking after discharge.
  • You decide you want to find out if this minimal contact intervention works in the long term.

P: patient/problem/population

Questions to think about:

How would you describe this population? (age, race, sex, healthy, risk factors, previous or current ailments, current medications, etc.)

  • What are the most important characteristics?
  • Relevant demographic factors
  • Is there a specific setting?

How is the condition defined? (symptoms, presence and/or severity of disease, diagnostic test, etc.)

Are there any patients who should be excluded from this population? (healthy patients, patients above or below a certain threshold, etc.)

I: intervention

Questions to think about:

What main intervention, treatment, diagnostic test, procedure, prognostic factor, or exposure are you considering?

Are you interested in a drug treatment? Medical procedure? Surgical procedure? Diagnostic test?

For drug interventions, what is the dosage, frequency, duration, and method of administration?

C: comparison

Questions to think about:

What is the main alternative to your intervention? (A different dosage of the same drug? Placebo or alternative drugs? Another medical or surgical procedure?)

  • Inactive control intervention: Placebo, standard care, no treatment
  • Active control intervention: A different drug, dose, or kind of therapy

For diagnostic studies, is there a gold standard or another diagnostic tool with which to compare yours?

O: outcome

Questions to think about:

What are you hoping to accomplish, measure, improve, or affect?

  • Be specific and make it measurable
  • It can be something objective or subjective

Do you want to improve quality of life?

Are morbidity or mortality important issues to consider?

What are the harms of this treatment or test and its alternatives?

Also consider...

Some PICO questions include a T or an S at the end (PICOT, PICOS, PICOTS).  The T usually stands for Type of study, Timeframe of study, or Type of question. The S can stand for Setting or Study Design.

For example, you may want to search for studies in the setting of nursing homes.