PICO Question Assignment Guidelines
25 points
Using the information and resources from Chapter 3 and the supplemental video series and
accompanying activity by Kristin Whitman, ISU Health Sciences Librarian, apply the first two
steps in the EBP process as discussed in Chapter 3 to complete this assignment.
Patient Case #1: A 49-year-old Caucasian female with a history of increased cardiometabolic
risk (increased triglycerides, elevated low-density lipoprotein cholesterol [LDL-C], overweight)
is visiting her primary care provider (PCP) for her yearly health check. She has gained some
weight in the past year and read on some websites that the ketogenic (keto) diet can help with
losing weight. The patient asks her PCP about whether she should try the keto diet to lose
weight. Her PCP is concerned about the potential effects of the diet for this patient given her
history of elevated LDL-C and wonders if there is a better dietary pattern for her to follow for
successful weight loss that would also benefit her other cardiometabolic risk factors.
Patient Case #2: A 45-year-old African American male completes a physical at the onsite health
clinic where he works. His blood pressure is 135/80 mmHg, which is considered stage 1
hypertension (HTN). The clinician completing his physical suggests that the patient begin
medication to treat his HTN and wants to prescribe lisinopril. The patient remembers that his
father had mild HTN and was able to manage it with lifestyle habits instead of medication. Thus,
the patients wants to discuss and try other options first.
Step 1: Choose one of the patient case scenarios. Based on that patient case scenario, complete
the PICO table below.
P
I
C
O
Step 2: After completing the PICO table, develop a complete and thorough PICO question. Be
sure to include all of the elements of a PICO question as described in the Chapter 3 lecture and
supplemental lectures posted on Moodle.
Step 3: Based on the examples in Chapter 3 and the activity you completed in Kristin’s lectures
(videos #4 and #5), complete a keyword table for words/concepts extracted from the PICO
question you created in Step 2. Please list all of the concept keywords and synonyms that you
used to narrow your search. You can add columns to the table as needed.
Concept 1 – [insert
here]
Concept 2– [insert
here]
Concept 3 – [insert
here]
Concept 4– [insert
here]
Keyword1
Keyword2
Keyword3
Etc.
(keywords are
synonyms, related,
variant spellings of
concept 1)
Keyword4
Keyword5
Etc.
Step 4a: After completing Steps 1-3, complete a literature search using the concept keywords
and synonyms from Step 3 and the tips provided by Kristin Whitman in her lectures to
find a research article of the highest level of evidence to answer your PICO question. As
you complete the literature search, identify and list the keywords or phrases that did not fit with
your PICO question keywords and would not help you find an appropriate research article to
answer your PICO question.
Search Words or Phrases to Exclude
Step 4b: As you complete your literature search using the keywords you brainstormed in
Step 3, identify a research article to submit as evidence to answer your PICO question.
Please note that you need to find a research article, not a review article, editorial, or
commentary article. Examples of appropriate research articles are those listed in the higher
levels of evidence described in Chapter 2, including clinical guidelines with ratings, systematic
reviews and meta-analyses, randomized controlled trials, clinical trials, and observational
studies. If you are having a hard time finding an appropriate research article, please utilize more
than one literature search database or resource to identify and select the research most relevant to
your PICO question. You can also email me to confirm that the article you are planning to
use for the assignment is an appropriate article.
After choosing an article with the highest level of evidence to answer your PICO question,
provide the citation for your article using either APA or AMA style. Please list the citation
of the article accurately to receive full points for this part of the assignment. Please review the
handouts available at the ISU Writing Center for APA formatting or the Owl at Purdue for AMA
formatting. Indicate the resource in which you found the article and attach a PDF copy of the
article or a hyperlink (if the hyperlink is to an open public page and not a website that requires
a login).
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Formulating
Focused Questions
and Locating
Relevant Evidence
CHAPTER 3
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Learning Objectives
Explain the evidence-based practice process
Recognize differences between patient/population, action, alternative action,
result, and evidence (PPAARE) and patient/problem/population, intervention,
comparison, and outcome (PICO) questions
Construct PICO questions applicable to situations related to individual patient
care, public or community health, epidemiology, and patient experiences or
perceptions
Translate the PICO components into searchable words or phrases
Locate the highest level of relevant evidence using effective and efficient
strategies in point-of-care products, in databases, with search engines, and on
credible websites
Record searches and organize relevant evidence using a structured approach
Define the key vocabulary terms of the chapter
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Recommended Learning Activities
Read Chapter 3: Formulating Focused Questions and Locating Relevant
Evidence
Watch the video series, “Introduction to Searching,” posted on the course
Moodle page and complete the search activity provided by Kristin Whitman
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Patient-Centered EBP Process
Figure 3-2 Patient-Centered EBP Process
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Step 1: Formulate a Focused Question – PPAARE
P = Problem
Diseases or conditions
P = Patient or Population
Demographics and modifiable risk factors
A = Action
Interventions related to diagnosis, treatment, etc.
A = Alternative Action (not a required component)
Options for interventions, including no intervention or watchful waiting
R = Result
Outcome or goal of the intervention
E = Evidence
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Step 1: Formulate a Focused Question – PICO
PICO is a more commonly used acronym in health science research
Similar to PPAARE
Sometimes seen as PICOT
P = Patient problem or population
The two “Ps” from PPAARE
Diseases or conditions, demographics (sex, race, age, geographical location), risk
factors
I = Intervention (sometimes, an “E” is used to represent an exposure)
The first “A” from PPAARE – Action
Interventions related to diagnosis and treatment
Examples
Dietary therapy (intervention) to treat a disease like dyslipidemia or diabetes
Effects of second-hand smoke (exposure) on health
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Step 1: Formulate a Focused Question – PICO, continued
C = Comparison
The second “A” from PPAARE – Alternative Action
An alternative treatment, usual care, no intervention, or watchful waiting
O = Outcomes
The “R” from PPAARE
Outcome or goal of the intervention
Time = Time Frame
This element is not always included when creating focused questions
Will not be a focus for the assignments in this course
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Examples of PICO for Different Health Care Areas
PICO
Component Patient Care
Population/
Public Health Epidemiology Patient Experiences
P Dyslipidemia –
LDL‐C
Overweight as a risk
factor for ASCVD in
Bannock Co. residents
Higher number of FH patients
in certain populations
Patient feelings related
to elevated LDL‐C and
risk of ASCVD
I Mediterranean
dietary pattern
Supervised group
physical activity
program to promote a
healthy weight
Genetic registries to identify
and follow FH patients
Gain knowledge of
client’s experience
C DASH dietary
pattern
Self‐guided, online
physical activity
program to promote a
healthy weight
No genetic registry Not applicable
O Identify which
dietary pattern
achieves most
improvement in
LDL‐C levels
Identify which
physical activity
intervention does best
to help achieve
healthier weight
Improved identification of FH
patients in countries with
genetic registries
Reduce anxiety and
improved ability to
address LDL‐C levels
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Application of a PICO Question
Patient Care Example: A mother accompanies her 15-year-old-son to an
appointment at the family physician’s office to receive a physical for playing
football. The mother asks the health care provider whether her son should get
the human papillomavirus (HPV) vaccine, the same one that her daughters
received when they were teenagers.
Identify:
Patient Problem or Population
Intervention
Comparison
Outcome
Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
Application of a PICO Question
Patient Care Example: A mother accompanies her 15-year-old-son to an
appointment at the family physician’s office to receive a physical for playing
football. The mother asks the health care provider whether her son should get
the human papillomavirus (HPV) vaccine, the same one that her daughters
received when they were teenagers.
Identify:
Patient Problem or Population: Risk of contracting HPV and its associated health
risks in a 15-year-old male
Intervention: HPV vaccination
Comparison: No vaccination
Outcome: Reduced risk of negative health effects related to HPV in males
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Formulating a PICO Question
Write a PICO question related to this patient case example.
What is the highest level of evidence available to determine whether a patient
with (P=disease or condition) benefits from (I=intervention) as compared to
(C=comparison) to produce, improve, or reduce the (O=outcome)?
What is the highest level of evidence available to determine whether a 15-year old male with the potential risk for contracting HPV benefits from receiving
the HPV vaccination as compared to not receiving the vaccination to
reduce the health risks associated with HPV in males?
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Step 2: Locate Relevant Evidence to Answer Focused
Questions
Thorough discussion in Chapter 3 on how to search available resources to find
the highest level of evidence
Video series created by Kristin Whitman, ISU Health Sciences Librarian
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Chapter Summary
The EBP process includes 5 steps – Chapter 3 focuses on the first 2 steps
1. Formulating focused questions
2. Locating relevant evidence
Mnemonic acronyms available to help you identify focused questions
PPAARE
PICO – this is the acronym most commonly used in health sciences
Developing PICO questions helps you to be more successful at locating the
highest level of evidence to answer your focused questions
Identify searchable words or phrases
Use effective and efficient strategies in various resources
Point-of-care products, literature databases, search engines, and credible websites
Record searches and organize relevant evidence using a structured approach
PICO Question Grading Rubric
Potential Points 4 points 3 points 2 points 1 point 0 points
PICO Table Completes the PICO table
with all 4 of the elements
based on one of the patient
case scenarios.
Completes the PICO table
with 3 of the 4 elements
based on one of the patient
case scenarios.
Completes the PICO table
with 2 of the 4 elements
based on one of the patient
case scenarios.
Completes the PICO table
with 1 of the 4 elements
based on one of the patient
case scenarios.
Does not complete the
PICO table.
Potential Points 4 points 3 points 2 points 1 point 0 points
PICO Question Develops a PICO question
that includes all 4 of the
elements of a well-written
PICO question based on one
of the patient case scenarios.
Develops a PICO question
that includes 3 of the 4
elements of a well-written
PICO question based on
one of the patient case
scenarios.
Develops a PICO question
that includes 2 of the 4
elements of a well-written
PICO question based on
one of the patient case
scenarios.
Develops a PICO question
that includes 1 of the 4
elements of a well-written
PICO question based on
one of the patient case
scenarios.
Does not write a PICO
question or writes a PICO
question that does not
include any of the elements
of a PICO question
