Evidence Based Practice Tutorial at Duke University
American Nurses Association Research Toolkit
1. ASSESS the patient: Start with the patient - a clinical problem or question arises from the care of the patient
2. ASK the question: Construct a well built clinical question derived from the case
3. ACQUIRE the evidence: Select the appropriate resource(s) and conduct a search
4. APPRAISE the evidence: Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)
5. APPLY: talk with the patient: Return to the patient - integrate the evidence with clinical expertise, patient preferences, and apply it to practice
PICO is a mnemonic that helps one remember the key components of a well focused question. The question needs to identify the key problem of the patient, what treatment you are considering for the patient, what alternative treatment is being considered (if any) and what is the outcome you want to avoid or promote.
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.
Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient? Age? Co-existing problems? Has the patient been exposed to something? Asbestos? Cigarette smoke?
What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question does not always need a specific comparison.
What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores?
More information on 'Types of Studies' on this page from the Evidence Based Practice Tutorial at Duke University: http://www.hsl.unc.edu/services/tutorials/ebm/studies2.htm
This tutorial was developed by Connie Schardt, Duke University Medical Center Library and Jill Mayer, University of North Carolina at Chapel Hill Health Sciences Library. Robert Ladd, HSL at UNC-Chapel Hill designed the graphics and the user interface. View the full tutorial from the beginning here: http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htm