PICO(T) Questions and an Evidence-Based Approach

PICO(T) Questions and an Evidence-Based Approach

PICOT questions optimize research by allowing the researcher to avoid bias. The researcher formulates key terms to be used in the search process. These terms are related to the selected population, intervention, comparison group outcome, and timeframe. This paper explores a practice issue of concern, formulates a PICOT question, identifies sources of evidence, and evaluates the relevance of findings to the PICOT question.

Practice Issue to be Explored Via the PICO(T) Approach

Asthma management is an issue of concern that will be explored. This disease affects children, adolescents, and adults. It is associated with high rabidity rates. CDC.gov (2022) reports that more than twenty-five million cases of asthma have been recorded in the USA. People aged below eighteen years account for about four million of these cases, whereas those aged eighteen and above account for about twenty-one million cases (CDC.gov, 2022). Furthermore, the prevalence of asthma is higher in females compared to males (CDC.gov, 2022). This condition lowers patients’ quality of life by predisposing them to periodic cough, wheezing, shortness of breath, and chest tightness (Marckmann et al., 2020). Pharmacological approaches embrace a stepwise approach. They include medications such as corticosteroids, bronchodilators, and leukotriene modifiers (Marckmann et al., 2020).

The PICOT question, in this case, is, Among patients with mild to moderate asthma, does the use of once-daily corticosteroid therapy compared to twice-daily therapy optimize medication adherence and improve patient outcomes after three months? In this context, the population comprises patients with mild to moderate asthma. The intervention is the use of once-daily corticosteroid therapy, and the comparison involves the use of twice-daily corticosteroid therapy. The outcome is optimized medication adherence and improved patient outcomes, and lastly, the timeframe is three months.

Sources of Evidence

Relevant sources of evidence that can be used to answer the PICOT question include online databases and credible organizational websites. To begin with, organizational websites are useful sources because they have policies, procedures, and guidelines. However, the credibility of information sourced from these websites depends on whether or not they are updated regularly. Furthermore, researchers can locate credible websites by checking their domains. USC.edu.au (2023) reports that credible websites have the following domains: .edu, .org, and .gov. These domains represent educational institutions, registered organizations, and governmental agencies, respectively (USC.edu.au, 2023). In this context, various websites, such as CDC.gov, publish relevant information about asthma that can be used in research.

Online databases provide access to peer-reviewed articles, case studies, and abstracts. They allow the user to customize their searchers to achieve specificity; for instance, a user can specify the currency of peer-reviewed articles. Furthermore, the user can use key terms to optimize search results. Access to unlimited resources enables the user to appraise peer-reviewed articles to select the best source of evidence. To accomplish this, researchers can leverage the CRAAP test. The CRAAP test evaluates the “currency, relevance, accuracy, authority, and purpose of a source” (Esparrago-Kalidas, 2021, p. 4). This test allows researchers to make informed decisions when selecting peer-reviewed articles and other resources to be included in the research. Examples of these databases include PubMed, Embase, and Google Scholar. In the context of the PICOT question, keywords to facilitate searches include “asthma” and “once daily corticosteroids therapy.”

Findings from Articles

According to Ginasthma.org (2023), inhaled corticosteroids are the mainstay reliever medications used in the management of asthma. These corticosteroids are introduced in a stepwise fashion, and the dose is modified based on the severity of asthma (Ginasthma.org, 2023). They play a significant role in minimizing airway inflammation and providing adequate symptom control (Marckmann et al., 2020). Inhaled corticosteroids can be administered once or twice daily, depending on the medication. Examples of inhaled corticosteroids that can be administered once daily include mometasone and budesonide (Kazi et al., 2021). According to Stanford et al. (2019), once-daily dosing produces optimal outcomes when the medication is administered in the evening. Furthermore, Stanford et al. (2019) note that once-daily dosing is not recommended for patients presenting with severe symptoms.

Drouin et al. (2022) conducted a quantitative study to determine adherence to medication among children receiving once-daily inhaled corticosteroids compared to those receiving twice-daily dosing. Drouin et al. (2022) report that children who received a single daily dose of inhaled corticosteroid demonstrated a higher medication adherence rate compared to those receiving twice daily dosing. The population receiving once-daily dosing had an adherence rate of about 67 per cent, whereas those receiving twice-daily dosing had an adherence rate of about 58 per cent (Drouin et al., 2022). Similar findings have been reported by Averell et al. (2021). According to Averell et al. (2021), patients receiving a once-daily dosing regimen demonstrated higher medication awareness levels compared to the other population. Notably, the difference in medication adherence between once and twice daily dosing was about 7.2 per cent (Averell et al., 2021). As such, administering a single dose of inhaled corticosteroid daily will improve medication adherence and improve the prognosis of the disease by providing adequate symptom control.

Relevance of Findings from the Chosen Sources

The findings are relevant to the PICOT question. Firstly, Drouin et al. (2022) report that children who received a single daily dose of inhaled corticosteroid demonstrated a higher medication adherence rate than those receiving twice daily dosing. The population receiving once-daily dosing had an adherence rate of about 67 percent, whereas those receiving twice-daily dosing had an adherence rate of about 58 percent (Drouin et al., 2022). These findings will be used to answer the PICOT question. In this context, a once-daily dosing of inhaled corticosteroids will be implemented to optimize medication adherence. Secondly, Averell et al. (2021) report that patients receiving a once-daily dosing regimen demonstrated higher medication awareness levels compared to the other population. Notably, the difference in medication adherence between once and twice daily dosing was about 7.2 percent (Averell et al., 2021). These findings will be used to answer the PICOT question by implementing once-daily dosing of inhaled corticosteroids. Thirdly, Stanford et al. (2019) report that once-daily dosing produces optimal outcomes when the medication is administered in the evening. These findings will guide the implanting of the PICOT question. In this context, the single daily doses of inhaled corticosteroids will be administered in the evening.

Conclusion

Asthma is a problem of concern that should be managed adequately. The significance of this disease is evidenced by its prevalence and impact on people’s quality of life. The disease affects individuals across all life spans. In the USA, the majority of cases have been reported among people aged eighteen years and above. Inhaled corticosteroids used in asthma management can be administered once or twice daily. Nonetheless, once-daily administration is associated with higher levels of medication adherence compared to twice-daily therapy.

References

Averell, C. M., Stanford, R. H., Laliberté, F., Wu, J. W., Germain, G., & Duh, M. S. (2021). Medication Adherence in Patients with Asthma Using Once-Daily Versus Twice-Daily ICS/LABAs. Journal of Asthma, 58(1), 102–111. https://doi.org/10.1080/02770903.2019.1663429

CDC.gov. (2022). Most Recent National Asthma Data. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Drouin, O., Smyrnova, A., Bétinjané, N., Ducharme, M. F. (2022). Adherence to Inhaled Corticosteroids Prescribed Once vs Twice Daily in Children with Asthma. Annals of Allergy, Asthma & Immunology, 128(4), 423-431. https://doi.org/10.1016/j.anai.2022.01.018

Esparrago-Kalidas, A. J. (2021). The Effectiveness of CRAAP Test in Evaluating Credibility of Sources. International Journal of TESOL & Education, 1(2), 1–14.

Ginasthma.org. (2023). Reports. https://ginasthma.org/reports/

Kazi, A. A., Subba Reddy, B. V., & Ravithej Singh, L. (2021). Synthetic Approaches to FDA-Approved Drugs for Asthma and COPD from 1969 to 2020. Bioorganic and Medicinal Chemistry, 41(February), 116212. https://doi.org/10.1016/j.bmc.2021.116212

Marckmann, M., Hermansen, M. N., Hansen, K. S., & Chawes, B. L. (2020). Assessment of adherence to asthma controllers in children and adolescents. Pediatric Allergy and Immunology, 31(8), 930–937. https://doi.org/10.1111/pai.13312

Stanford, R. H., Averell, C., Parker, E. D., Blauer-Peterson, C., Reinsch, T. K., & Buikema, A. R. (2019). Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid/Long-Acting β-Agonist for Asthma. Journal of Allergy and Clinical Immunology: In Practice, 7(5), 1488-1496.e7. https://doi.org/10.1016/j.jaip.2018.12.021

USC.edu.au. (2023). What are credible sources? https://libguides.usc.edu.au/credible/web

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Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

PICO(T) Questions and an Evidence-Based Approach

It stands for:

P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgment skills. When reliable and relevant evidence-based findings are utilized, outcomes for patients, health care systems, and nursing practice are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, a potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison of the outcome you desire.

Scenario
For this assessment, please use a healthcare issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions
For this assessment, a health care issue of interest must be selected, and the PICO(T) process must be applied to develop and research the research question.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant, and you should include that as well. When writing a question, you can research something related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well as explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella Library’s Evidence-Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
Explain the findings from articles or other sources of evidence as they relate to the identified healthcare issue.
Explain the relevance of the findings from chosen sources of evidence to making a decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF].
Additional Requirements
Your assessment should meet the following requirements:

Length of submission: Create a 3-5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting: Format references and citations according to the current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
Explain the findings from articles or other sources of evidence that are relevant to the health care issue.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the relevance of the findings from chosen sources of evidence to making a decision related to a PICO(T) question.
Competency 3: Apply an evidence-based practice model to address a practice issue.
Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
Organize content so ideas flow logically with smooth transitions; contain few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.