Evidence-Based Practice in Health Care: The PICO Framework

PICO Case Study: Patient Education

Clinical Scenario 1

• 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 smoke chronically 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: Consider when choosing your patient/problem

• What are the most important characteristics?
• Relevant demographic factors
• The setting

I: Consider for your intervention

• What is the main intervention, treatment, diagnostic test, procedure, or exposure?
• Think of dosage, frequency, duration, and mode of delivery

C: Consider for your comparison

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

O: Consider for your outcome

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

PICO: Putting it together

Your full PICO question is:

Among hospitalized patients who chronically smoke, does a brief educational nursing intervention lead to long term smoking cessation [when compared with no intervention]?

Adapted from the original on the library website of the University of North Carolina, Chapel Hill.

PICO Case Study: Patient with Depression

Clinical Scenario 2

The patient is a 45-year-old female who is experiencing moderate depression. After surfing the web, she believes St. John’s Wort will cure her symptoms with less risk than conventional antidepressant medications.

If we analyse this scenario, using the PICO framework,

P:  Adults experiencing (moderate) depression
I:   St. John’s Wort
C:  Conventional Antidepressants
O:  Relief of Symptoms

We can form this PICO question:

In adults with moderate depression, is St. John’s Wort more effective for symptom relief than antidepressants?

PICO Case Study: Cancer Patient with Nausea

Clinical Scenario 3

On the Oncology unit, a first-year student has a question.  He wants to discuss options for managing moderate nausea/vomiting that result after chemotherapy.  He shares an experience that a relative had taking ginger when Ondanestron (Zofran) didn’t provide much relief.

If we analyse this scenario, using the PICO framework,

P:  Patients with nausea/vomiting after chemo
I:  Use of ginger
C: Ondanestron (Zofran) 
O:  Reducing nausea and vomiting

We can form this PICO question:

In chemo patients with nausea/vomiting, is use of ginger more effective than Zofran with relieving symptoms?