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Allied Health Subject Guide

Evidence-Based Practice and PICOT Questions

Evidence-based practice (EBP) combines research-based information, clinical expertise, and patients' values and preferences when providing care. This involves five steps known as the Five As:

  1. Ask: Convert your information needs into an answerable clinical (PICOT) question.
  2. Acquire: Find the best evidence to answer your clinical question.
  3. Appraise: Critically appraise the evidence for its validity, impact, and applicability.
  4. Apply: Integrate the evidence with clinical expertise, the patient's values and circumstances, and information from the practice context.
  5. Assess: Evaluate the outcomes of the applying the evidence to your practice.

This main focus of this guide is on Ask & Acquire - formulate an answerable question and find the best evidence for your question.

Pyramid with different types of studies listed by quality, from lowest (animal / laboratory studies) to highest (systematic reviews & meta-analyseWhen you begin your EBP research, keep the hierarchy of evidence in mind. The pyramid to the right shows a range of resources from the lowest levels (Background, animal research) to the highest levels of evidence (systematic reviews and meta-analysis). The base tiers, or lower levels, have more literature and usually this is where the research or idea starts.The higher tiers have less literature but the study design is stricter and they are considered more reliable for a clinic setting.

Ideally, you will be able to find systematic reviews on your topic, but remember that a systematic review may not have been written yet. Also remember that a randomized controlled trial may not have been an appropriate study for your topic.

What is a PICOT Question?

The PICOT question format is a consistent "formula" for developing answerable, researchable questions. When you write a good one, it makes the rest of the process of finding and evaluating evidence much more straightforward.

  • P - Population, patient, or problem
    • Examples: Age, gender, ethnicity, individuals with a certain disorder
  • I - Intervention or indicator
    • Examples: Exposure to a disease, risk factor, prognostic factor, treatment
  • C - Comparison or control
    • Examples: Placebo or no intervention, absence of risk factor, absence of disease
  • O - Outcome
    • Examples: Risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome
  • T - Time
    • Examples: The time it takes for the intervention to achieve an outcome or how long participants are observed

Examples from Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed). Wolters Kluwer/Lippincott Williams & Wilkins.

Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.
For example, your question might be: Is Vitamin C more effective than echinacea in reducing the recovery time for the common cold? You can break that down into the PICOT format and use those terms as keywords for your searches.

  • P: Adult with a cold
  • I:  Vitamin C
  • C: Echinacea
  • O: Reduced cold symptoms
  • T: Length of cold

The PICOT format will help you translate your question from an initial broad topic or a question specific to an individual patient's experience, to a concrete, objective question that you can find clinical evidence to answer

Recorded Workshop

Science and Allied Health Workshop: Evidence-Based Practice

Join the Science and Allied Health liaison librarians from the VSCS Libraries as they break down the best ways to search for articles. This week, we'll discuss evidence-based practice and how to locate EBP articles, which provide the most up-to-date health sciences research, along with real-life experiences from clinicians on how best to treat patients.

Nursing Liaison Librarians