Evidence-Based Decision Making: Introduction and Formulating Good Clinical Questions
Structuring the PICO Question

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Structuring the PICO Question

After understanding the elements of PICO and identifying the patient’s concerns, you are now ready to structure the PICO question for Mr. Logan’s case.

P = Patient Problem or Population
The first part of the PICO question begins with the following phrase: For a patient with... Inserting the patient’s chief complaint or condition completes this phrase. For Mr. Logan, this phrase can be completed as follows:
"For a patient with tooth discoloration due to coffee and tobacco".

I = Intervention
The main intervention being considered is Crest Whitestrips, so the question now reads:
"For a patient with tooth discoloration due to coffee and tobacco, will Crest Whitestrips".

C = Comparison
The comparison phrase is stated "as compared to" the main alternative, which in this case is custom trays for use with an at-home whitening/bleaching system. The question now reads:
"For a patient with tooth discoloration due to coffee and tobacco, will Crest Whitestrips, as compared to custom trays for use with an at-home whitening/bleaching system".

O = Outcome(s)
Mr. Logan’s main concern is the discoloration of his teeth and having his teeth as white as they were when he was 25 years old within a 1 week period. The outcome(s) is then phrased as, be as effective in whitening his teeth within 1 week. Based on these four parts, the complete PICO question can be stated as:
"For a patient with tooth discoloration due to coffee and tobacco, will Crest Whitestrips, as compared to custom trays for use with an at-home whitening/bleaching system, be as effective in whitening his teeth within 1 week?"

Following the PICO Worksheet (Table 5), you would then identify the type of question and study and then list any additional terms or phrases related to the already identified P, I, C, and O. By generating these words, alternative key terms are identified that facilitate finding evidence to answer your question, Step 2, conducting a computerized search with maximum efficacy, in the EBDM process. For example, key terms that could be used in the search are ‘tooth bleaching’ or ‘tooth whitening’ or ‘Crest Whitestrips’ or ‘whitening strips’ as well as ‘hydrogen peroxide’ or ‘carbamide peroxide.’ An example of a completed PICO Worksheet for Mr. Logan’s case is shown in Table 6.

Table 6. Completed PICO Worksheet for Mr. Logan's Case
table06
2001 SA Miller, PICO Worksheet, National Center for Dental Hygiene Research