PICO(T) Questions and an Evidence-Based Approach

While the importance of evidence-based research findings on nursing practice and patient care outcomes is irrefutable, nurses may struggle in the early stages of translating evidence into practice. The use of evidence-based models such as the PICO(T) question gives a starting point for nurses to apply evidence into practice. The PICO(T) question helps nurses to narrow their search for evidence and find more efficient and effective resources.

PICO(T) Questions and an Evidence-Based Approach

From the search, a nurse may easily obtain relevant and valuable information where a reasonable scientific foundation that supports patient care techniques can be generated. A PICO(T) question also allows nurses to isolate the intervention of interest and compare it to other existing interventions for evidenced impact on the concern’s outcomes.

The objective of this paper is to identify a relevant intervention PICO(T) in the context of chronic obstructive pulmonary disease (COPD), highlight the sources of evidence that are potentially effective in answering the question, and isolate two articles relating to the healthcare issue, stating their findings and relevance.

The PICO(T) Question in the Context of COPD

Among patients with COPD (P), does home-based care (I) lead to better symptom and cost management (O) compared to standard hospital-based care (C)? In this context, the population (P) refers to people with COPD, a chronic, preventable, and treatable respiratory illness characterized by various respiratory symptoms and airflow limitation. The condition’s prevalence varies greatly based on survey techniques, diagnostic criteria, and analytical procedures.

In a review of systematic analytic studies on the global epidemiology of COPD, one study documented that approximately 299 million people had COPD in 2015. Another systematic search of population-based studies across 52 countries documented that the Americas had the highest COPD prevalence (15% in 2010), and Southeast Asia’s 10% was the lowest (Ruvuna & Sood, 2020).

However, the disparities in data should not obscure the fact that, before the beginning of Covid19, COPD was the third highest cause of death worldwide (WHO, 2020), underlining the critical need to treat the illness and its repercussions. In the United States, it is estimated that around 6% of individuals aged ≥18 in 2020 had COPD (CDC, 2022).

The high mortality rate of COPD (3 million people died from it in 2015), as well as the significant disability-adjusted life years (DALY) it causes (it is estimated that COPD represented about 64 million DALYs in 2015, ranking eighth among causes of global disease burden worldwide), underscore the urgency of addressing the issue (Ruvuna & Sood, 2020). This demographic also bears a substantial economic burden, as it is estimated that in the European Union, it accounts for 56% (38.6 billion Euros) of the cost of respiratory disease and that the estimated direct cost of COPD in the United States is $32 billion, with indirect costs of $20.4 billion (GOLD, 2018; Iheanacho et al., 2020).

In addition to the social burden, where patients exhibit limitations in social behaviors and daily activities, possibly due to COPD symptoms and frequent exacerbations necessitating hospitalizations, COPD patients will benefit significantly from an evidence-based solution to alleviate their plight.

During the Covid19 era, the proposed intervention (I), home-based care, has received significant importance. The approach to home-based care for COPD patients is either a physical interaction with the patients, such as a home visit, or telemedical approaches, such as telephonic calls, text messaging, real-time audiovisual conferencing, or patient-care provider interaction platforms via websites and web portals.

This intervention will be compared to routine hospital-based visits (C) or outpatient treatment, in which a patient seeks an appointment with their primary care physician at regular intervals or only when there is a concern, such as a symptom exacerbation. Concerning the period of intervention (T), the numerous research studies that will be utilized to answer the PICO(T) question will submit the patients to varying durations of the intervention, making time not a constraint in future efforts to answer the question.

Sources of Evidence that can be Potentially Effective in Answering the PICO(T) Question

To answer a question concerning a healthcare issue, the sources from which the articles are obtained must be reliable nursing, medical, and healthcare-related databases. Journal search engines such as PubMed, ProQuest, MEDLINE, Cochrane Library, and EMBASE are examples of credible sources for nursing and medical information.

These search engines generate journal papers that include randomized controlled trials, systematic reviews, and meta-analyses. However, before putting the evidence into effect, one must first determine the relevance of the articles, which starts with the search technique being tailored to produce articles published during the last five years to match the currency requirements, and keywords related to the healthcare topic of interest are used to determine the relevance of the articles produced.

Besides journal search engines, credible health information may be accessed via websites such as the CDC, WHO, AHRQ, and NIH. While website names provide a hint of relevance, it is also prudent to check the dates of publication to ensure the currency, the domains of the websites (usually “.edu” and “.gov” are likely to provide credible information), and the credentials of the authors to distinguish credible information from regular blog posts.

Findings from Articles Addressing COPD and Determination of their Relevance         

Physical inactivity among COPD patients is linked to exacerbations needing high-cost healthcare, such as urgent, emergent, and inpatient treatment. Coultas et al. (2018) examine the efficacy of a behavioral lifestyle physical activity intervention in conjunction with COPD self-management education in reducing high-cost healthcare consumption.

The article analyzes secondary outcomes from a COPD self-management activation research trial, which was a two-arm randomized trial of stable COPD outpatients recruited from primary care and pulmonary clinics. The study included 325 participants, 149 in the intervention group (IG) and 156 in the usual care (UC) group.

Before randomization, each group received a 6-week self-management education, and after randomization, the IG received a telephone-delivered home-based health coaching intervention for 20 weeks, as well as a 25-chapter structured workbook on physical activity, while the control group relied on hospital visits as needed. Self-report at 6, 12, and 18 months defined secondary outcomes such as physical activity and healthcare usage.

The findings reveal that 73.6% of individuals in the IG reported being consistently active during 18 months, compared to 57.8% in the control group. Furthermore, among patients with severe spirometric impairment, the intervention was linked with a decreased incidence of lung-related utilization (adjusted rate ratio, 0.38; 95% confidence interval, 0.23-0.63).

The author found that a home-based coaching intervention improves sedentary behavior by raising physical activity levels, as well as reducing lung-disease-associated healthcare consumption, sparing patients from expensive frequent hospitalizations. The article’s credibility is demonstrated by its currency, having been published within the last five years, relevance as it addresses the topic of concern, accuracy due to the extensive backup of sources, and the fact that it is authored by medical luminaries, particularly respiratory medicine specialists.

After realizing that the effectiveness of PR reduces with time, Li et al. (2018) investigated home visiting and phone contact as a strategy to preserve the benefits of pulmonary rehabilitation (PR) for patients with COPD. A total of 172 patients were randomly assigned to one of two groups: intervention or UC. The IG received an 8-week PR program of aerobic training, upper resistance training, and respiratory training facilitated through home visits and phone contact.

In contrast, the UC group received health education on smoking cessation and oxygen therapy when they experienced respiratory failure, as well as dietary and nutrition consultation and necessary pharmacologic therapy. The results were as follows: 151 patients completed the 8-week PR therapy with good PR outcomes (p,0.001), and 104 completed the follow-up. Clinical improvements in the six-minute walk test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) scores were maintained in PR Maintenance Group [PRMG] (p,0.001).

In the UC group, however, the advantage of PR progressively faded. Six, nine, and six months after PR, there were variations in 6MWT, CAT, and mMRC scores across groups (p,0.05). The total incidence of exacerbations in PRMG was lower than in UC (p=0.021), with the author concluding that a maintenance plan comprising home visits and phone contact is preferable to standard care in preserving PR benefits and advocating for more deployment of such strategies.

The results are credible and may be taken into practice due to the article’s currency (being published within the previous five years), relevance in addressing the healthcare problem of concern, having a rich supply of evidence to back the assertions, and being written by medical cognoscenti.

Conclusion

The importance of incorporating evidence-based results into nursing practice and patient care cannot be overstated. As a result, healthcare professionals must understand how to find appropriate sources and how to translate the information into practice. Most care providers begin the translation of evidence into practice with the PICO(T) question.

The PICO(T) question enables healthcare practitioners to characterize the healthcare problem of concern accurately and search for relevant information on suggested interventions to address the issue while comparing the intervention to others already available. A caregiver is thus able to back up all the assistance they provide to patients with a scientific rationale, assuring patient safety and quality.

References

Assignment Description: PICO(T) Questions and an Evidence-Based Approach

Create a 3-5 page submission in which you develop a PICO(T) question for preeclampsia 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. 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 judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted. PICO(T) is a framework that can help you structure your definition of the issue, 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 on 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, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it. 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 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 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 it relates to the identified health care issue. •	Explain the relevance of the findings from chosen sources of evidence to making 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. •	 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 decisions 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; contains 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.