Evidence-Based Decision Making: Introduction and Formulating Good Clinical Questions
Evidence-Based Decision-Making in Action

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Evidence-Based Decision-Making in Action

The PICO Process (Skill/Step 1)

The formality of using PICO to frame the question forces the questioner to focus on what the patient/client believes is the most important problem and the desired outcome. Doing this facilitates selecting language or key terms for conducting the computerized search, the second step in the process. Next, it allows you to determine the type of evidence and information required to solve the problem and the outcome measures that will be used to determine the effectiveness of the intervention.

One of the greatest difficulties in developing each aspect of the PICO question is providing an adequate amount of information without being too detailed. Each component of the PICO question should be stated as a concise short phrase as illustrated in the following case example.

Case Example

Your new patient, Mr. Jim Logan, is a 48-year old marketing executive. His chief complaint is the/discoloration of his front teeth, which he feels is getting worse as he gets older. He would like them to be as white as they were when he was 25 and even brought in a picture to show you. He would like them whitened within one week before he attends his 30-year high school reunion. When reviewing his health history and behaviors, you learn that Mr. Logan is a coffee drinker and recently stopped smoking. Upon examination, you determine his only treatment needs are preventive care and suggest you re-evaluate the discoloration after that appointment since the stain could be removed during his prophylaxis. If additional treatment is needed, you can make him custom trays for use with an at-home whitening/bleaching system.

You present the bleaching procedure options and related fees to Jim. He questions you about the differences between them and the Crest Whitestrips that do not require a tray and can be purchased at the local grocery store. Jim insists the whitening strips are just as effective and cost considerably less.

You are not familiar with the latest scientific literature on the whitening strips to answer Mr. Logan’s questions thoroughly. You tell him you know the bleaching procedures you have suggested are safe, effective, and can produce the desired outcomes within the desired time. However, you tell him you will be glad to investigate the Whitestrips option so each of you are fully informed about the pros and cons of each method before selecting a treatment. With the popularity of these treatment options and new products introduced quite frequently, this information will be a valuable addition to the evidence-based "library" you are creating in your office. To find the answer, you must define Jim’s question so it facilitates an efficient search of the literature. To guide this process, the PICO Worksheet and Search Strategy form can assist you. (Table 5)

Table 5. PICO Worksheet for Mr. Logan's Case
2001 SA Miller, PICO Worksheet, National Center for Dental Hygiene Research