A PICOT Question Does Not Have to Be in Order?

In case you’re wondering whether a PICOT question has to be in order, that is exactly what we are going to answer in a few, clear sentences.

First, writing a PICOT question is inevitable for nurses and students in med school.

If you’re a registered nurse or you study a healthcare-related course, you will be required to conduct research inquiries with an evidence-based practice framework. You’re supposed to generate from a proper PICOT question, regardless of whether they are completing advanced nursing education or practicing in a clinical setting.

What is a PICOT Question?

The acronym PICOT is an abbreviation for the parts of a clinical research question – patient, intervention, comparison, outcome, and (in certain cases) time – and is used to denote those 4 or 5 elements.

Starting with a case scenario, the PICOT method moves on to phrasing the question so that it elicits an answer.

The PICOT question must specify which patient or group we aim to research, what intervention or therapy we intend to employ, if one intervention will be compared to another (if appropriate), and what outcome we expect.

This is according to EBSCO Health’s whitepaper “7 Steps To The Perfect Pico Search” states that this is the case. In the paper by Kathy A. Jensen, MHA, RN, researchers will be better positioned to explore the literature for evidence that will support their initial PICO question after a well-structured question has been established, according to the authors.

Learning how to construct a detailed PICOT question is crucial for RNs pursuing a doctor of nursing practice (DNP) degree program, especially an online DNP program, in order to acquire nurse manager abilities. PICOT question samples are studied by DNP students in order to discover the optimal technique for formulating a question and getting an answer.

Does a PICOT Question has to be in Order?

No, a PICOT question does not have to be in any order because research questions vary as shown in the list of possible formats below. Arranging the individual parts of the query will depend on the goal of writing it and the nature of exploration the student is making.

Let us look at the example below.

  • “Does hand washing (I) among healthcare professionals minimize (O) hospital acquired infections (P) when compared to an alcohol-based solution (C)?”

If you’re asking a question regarding the etiology or potential injury, use the letter “E” for the letter “I.” E would stand for the level of exposure a patient received.

After writing your PICO question, you may break down every individual component into a search strategy that will help you find the answer. Two additional letters will be required for your mnemonic: T (Type of Question) and T (Type of Study).

Your PICOT Question can follow any of the following 6 orders, patterns or styles, but still achieve the same objective.

The order for writing your PICOT question (6 examples)

(a) When investigating an intervention or treatment

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

(b) When exploring etiology

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

(c) When examining a diagnosis

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

(d) Discussing prevention strategies

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

(e) When investigating prognosis

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

(f) When investigating meaning

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

It is easy to understand the aim of a PICOT inquiry: it is a technique for identifying the ideal keywords that should be utilized in order to look for the best evidence to address a pressing clinical concern. In other words, the PICOT question serves as the basis for developing a search strategy. The search method results in a search that is both unbiased and effective.

The evidence is discovered via an unbiased and effective search.

The evidence provides a response to the issue and serves as the foundation for any evidence-based recommendation, decision, or practice.

The use of a correctly written PICOT question when conducting a search results in the discovery of a small number of relevant studies to answer the clinical question, rather than the exploration of hundreds of studies, the majority of which do not answer the research questions because the PICOT question was poorly designed.

PICOT Question Example

In elderly patients with chronic neck pain, how does the minimal dosage of manipulation required to achieve a clinically significant improvement compare with supervised exercise over a 6-week period.

P) – Population: Elderly patients aged 60 years old who have a clinical diagnosis of persistent mechanical neck pain and have not undergone cervical SMT in the previous year were included in this study. No patients will be accepted if they have non-mechanical neck discomfort or if they have contraindications to cervical manipulation.

(I) – Intervention: Subjects who were assigned to undergo manipulation will receive normal rotary or lateral break varied method once, twice, or three times per week for a period of 2, 4, or 6 weeks, depending on their presentation. These individuals would also be subjected to the same exercise program as the control group in order to exclude exercise as a potential second variable influencing results.

(C) – Comparison: An active control group would be comprised of participants who participated in a structured, supervised exercise routine. Everyone in the study, regardless of their group assignment, was required to participate in a standardized exercise program at each session over the course of six weeks. We will be able to reduce the non-specific side effects associated with attending a clinic if we follow this method.

(O) – Outcome: – Indicators of success include changes in neck discomfort as evaluated by pain scores or scales.

(T) – Time: The outcome would be assessed on a weekly basis for a period of six weeks.

How to Formulate a PICOT Question

Most of the time, the PICOT process begins with a broad clinical question or a nonspecific clinical enquiry.

Each step in the process contributes to the development of a well-structured query.

Once a research question has been developed, researchers can begin searching for evidence that will aid them in answering the question.

Researchers must establish a need or rationale for the study before designing a PICOT question. The following is a general example from the EBSCO Health whitepaper: A committee agrees to undertake a case study to see if after gum chewing for patients undergoing abdominal surgery can help avoid postoperative ileus (lack of intestinal movement).

With the situation in mind, researchers conduct a PICOT search in seven steps:

1. State the PICOT question in broad terms. An example would be something like this:

“In patients recovering from colorectal surgery, is there evidence that suggests gum-chewing postoperatively, compared to not chewing gum, impacts postoperative ileus?”

2. Determine the keywords for the PICOT

P – Patients undergoing abdominal surgery

I — Chewing gum

C – Not chewing gum.

O — Has an effect on post-operative ileus

3. Develop a search strategy: Keeping the topic in mind, researchers evaluate which databases and other search sites they may utilize to obtain information and answers. To optimize their search keywords, researchers employ methods such as seeking for synonyms and phrases that imply the same thing.

4. Conduct a search: At first, researchers search each PICOT element separately. For example, while looking for people recuperating from abdominal surgery, use the search words “abdominal surgery,” but also “recovery and postoperative.”

5. Refine the results: Narrow the search results by restricting the works to relevant information, such as peer-reviewed journal articles or research documents.

6. Examine the content: Examine the study findings to see if they provide enough information to answer the PICOT question.

7. Assess if study findings satisfy standards: After examining the findings, determine whether they give the best available evidence.

8. Decide whether study findings satisfy standards: After reading the research findings, determine whether they represent the best available evidence.

After the PICOT question has been developed and studied, the information gathered is utilized to identify which sort of study is the most suited for the situation.

Meta-analysis, systematic review, randomized controlled trial, cohort study, case-control study, and case report are some of the research kinds that are available.

Many people find the actual search for high-quality clinical research data to be daunting, according to Jensen, who wrote an EBSCO Health whitepaper on the subject.

By adopting the PICO framework, the search process will be simplified, and the best available evidence to support clinical judgments as well as investigate alternate treatments and procedures will be uncovered.