The Problem With PICO for Finding the Best Evidence: Fishing With the Wrong Bait and the SEARCH Solution

Tucker, Sharon; Edmonds, Stephanie W.; Cullen, Laura; Hanrahan, Kirsten; Laures, Elyse

doi:10.1016/j.jopan.2023.07.002

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…Students also used the PICOT method for the project purpose in over half of the DNP projects in this study. Clinicians and faculty have identified this as a common problem in the clinical setting and academia (Cullen et al., 2023; Gallagher Ford & Melnyk, 2019; Schiavenato & Chu, 2021; Tucker et al., 2023). Knowledge and proper execution of the steps of the EBP process can help to resolve this problem.…”

Section: Discussionmentioning

confidence: 99%

“…Poorly taught and written PICOT questions lead to a problematic EBP process (Gallagher Ford & Melnyk, 2019). This may help explain the perception of nurses misusing the PICOT method to identify the project purpose, which can lead to selecting a solution to address the clinical problem long before a search for evidence has even begun or the critical appraisal and synthesis of the body of evidence has been completed (Cullen et al., 2023; Tucker et al., 2023). Furthermore, students may mistakenly hold the belief that the PICOT question is EBP (Schiavenato & Chu, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, students may mistakenly hold the belief that the PICOT question is EBP (Schiavenato & Chu, 2021). These issues have prompted some researchers, healthcare professionals, and health librarians to consider alternative strategies for asking clinical questions and conducting searches for evidence (Cullen et al., 2023; Hateley, 2023; Kloda et al., 2020; Schiavenato & Chu, 2021; Tucker et al., 2023).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

National evaluation of DNP students' use of the PICOT method for formulating clinical questions

Milner,

Hays,

Farus‐Brown

et al. 2024

Worldviews Ev Based Nurs

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BackgroundThe intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence‐based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence‐based practice process, DNP graduates' competence in the PICOT method needs to be better understood.AimsThis analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects.MethodsProject questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education‐accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus.ResultsAlthough the PICOT method was project author‐identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty‐three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0–5).Linking Evidence to ActionGaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non‐evidence‐based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP‐prepared nurses shore up this foundational skill.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

National evaluation of DNP students' use of the PICOT method for formulating clinical questions

Milner,

Hays,

Farus‐Brown

et al. 2024

Worldviews Ev Based Nurs

View full text Add to dashboard Cite

show abstract

“…The effectiveness of the PICOT method for formulating focused clinical questions and guiding systematic evidence searches has recently been questioned. [18][19][20] For instance, doubts have been raised about the intentional use of PICOT questions to state the aim or the purpose of the project, 18,20 which is not an appropriate use of PICOT formatting. Faculty can avoid this outcome by helping students understand that the synthesis of the body of evidence is what determines the project's purpose.…”

Section: Foundations For Guiding Nursesmentioning

confidence: 99%

“…24 Finally, it's been argued that the PICOT method is an outdated and limited approach to searching for the best evidence. 20 When the PICOT method is used correctly, it provides for a concise systematic search of electronic databases, 25 leading to the retrieval of only those articles relevant to the clinical question. When taught or used incorrectly, the PICOT method can lead to significant problems with the search, resulting in biased recommendations rather than the best evidence.…”

Section: Foundations For Guiding Nursesmentioning

confidence: 99%

Clinical Inquiry and Problem Identification

Hays,

Milner,

Farus-Brown

et al. 2024

AJN, American Journal of Nursing

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This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series—Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

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