PICOT - TEMPLATE

PICOT format increases the chances that you can find the best evidence in a timely and efficient manner to guide your practice.

Effective health care is based on the highest level of available evidence & avoids underuse of effective care. It also averts the use of ineffective care that is more likely to harm than to help a patient or wastes time and resources.

Seven Steps of EBP:

0. Cultivate a spirit of inquiry.

1.  Ask the burning clinical question in PICOT format.

a.  Patient population

b.  Intervention or issue of interest

c.  Comparison intervention or group

d.  Outcome

e.  Time frame

2.  Search for and collect the most relevant best evidence.

3.  Critically appraise the evidence.

4.  Integrate the best evidence with one’s clinical expertise, patient preferences, and values in making a practice decision or change.

5.  Evaluate outcomes of the practice decision or change based on evidence.

6.  Disseminate the outcomes of the EBP decision or change.

(Melnyk & Fineout-Overholt, 2010, p 11)

Question Templates for Asking PICOT Questions (Melnyk & Fineout-Overholt, 2010, p 31):

Intervention: In ______(P), how does ______(I) compared to ______(C) affect ______(O) within ______(T)?

Prognosis/Prediction: In ______(P) how does ______(I) compared to ______(C) influence/predict ______(O) over ______(T)?

Diagnosis or Diagnostic Test: In ______(P) are/is ______(I) compared with ______(C) more accurate in diagnosing ______(O)?

Etiology/Causation: Are ______(P) who have ______(I) compared with those without ______(C) at ______risk for/of ______(O) over ______(T)?

Meaning: How do ______(P) with ______(I) perceive ______(O) during ______(T)?

Patient population; Intervention or issue of interest; Comparison intervention or group, Outcome, Time frame

Search for the best evidence reflecting the highest level of evidence available.

Best Type of Evidence for Your Question

Type of Question / Ideal Type of Evidence to Search For (can even add as a key search word)
Intervention / 1.  Systematic reviews/meta analysis (synthesis) of RCTs
2.  RCTs
3.  Nonrandomized controlled trials
4.  Cohort study or case-control studies
5.  Meta-synthesis of qualitative or descriptive studies
6.  Qualitative or descriptive studies
7.  Expert opinion
Diagnosis or diagnostic test / 1.  Synthesis of cohort study or case-control studies
2.  Single cohort study or case-control studies
3.  Meta-synthesis of qualitative or descriptive studies
4.  Single qualitative or descriptive studies
5.  Expert opinion
Prognosis/Prediction
Etiology / 1.  Meta-synthesis of qualitative studies
2.  Single qualitative studies
3.  Synthesis of descriptive studies
4.  Single descriptive studies
5.  Expert opinion
Meaning

RCT = Randomized Controlled Trial

Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions

Level I / Evidence from a systematic review or meta-analysis of all relevant RCTs
Level II / Evidence obtained from well-designed RCTs
Level III / Evidence obtained from well-designed controlled trials without randomization
Level IV / Evidence from well-designed case-control and cohort studies
Level V / Evidence from systematic reviews of descriptive and qualitative studies
Level VI / Evidence from single descriptive or qualitative studies
Level VII / Evidence from the opinion of authorities and/or reports of expert committees

(as cited in Melnyk & Fineout-Overholt, 2010, p 12)

Reference

Melnyk, B.M. & Fineout-Overholt, E. (2010). Evidence-based practice in nursing &

healthcare: A guide to best practice (2nd edition). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

PICOT_TemplateR_fa11

2009 LKH: updated 06/24/11