Developing a PICO Question for PEN
Developed by PEN Canada Team members:
Dawna Royall, Tanis Fenton, Kristyn Hall,
Jayne Thirsk and Beth Armour
EBP Information Cycle
Assess
Ask
Appraise
Apply
Acquire
CHE Evidence-based tutorial; 2008
Ask
Types of Questions:
Background
§ General knowledge,
conditions, regulations
etc
§ Background document
template
Foreground
§ Specialized knowledge
§ About choices / decision
making
§ PEN PICO question
Background or Foreground
Questions?
1. How long does it take food to
enter breast milk and be eliminated
from it?
2. Does a breastfeeding mother’s diet
contribute to infant colic?
Background Information
Sources
n eMedicine (Medscape)
n Mayo Clinic
n Merck Manual Online
n Medline Plus Health Topics (NLM and NIH)
n NIDDK
n disease-related association websites
Population – how would you define your
population e.g. demographics, medical
condition?
Intervention or Exposure of interest – what
are the intervention or prognostic factors?
Comparison – is there an alternative or standard
practice to compare to? What comparison is
relevant?
Outcome – what do you hope to accomplish,
improve or effect? What outcome is important
to you and your patients/clients?
PICO Questions
Your PICO terms form your
research question
Examples:
u Among hospitalized patients, do dietetic
services improve quality of life or
mortality?
u Among patients with dysphagia, what is
the evidence that modified consistency
improves swallowing?
PICO Research Question
(example)
u Among hospitalized patients, do dietetic
services improve quality of life or mortality?
Ø P
Ø I
Ø C
Ø O
PICO Research Question
(example)
u Among hospitalized patients, do dietetic services
improve quality of life or mortality?
Ø P – adults hospitalized for bariatric surgery
Ø I – post-op bariatric surgery diet progression
Ø C – those post-op bariatric surgery who are allowed to eat ad-lib
Ø O – better quality of life and less incidence of vomiting
PICO Research Question
(example)
u Among patients with dysphagia, what is the
evidence that modified consistency improves
swallowing?
Ø P
Ø I
Ø C
Ø O
PICO Research Question
(example)
u Among patients with dysphagia, what is the
evidence that modified consistency improves
swallowing?
Ø P – adults with long-term dysphagia
Ø I – consuming modified consistency liquid and solid foods
Ø C – consuming regular consistency foods and liquids
Ø O – fewer incidences of chocking, weight maintenance
Types of inquiry in
Nutrition
§ Etiology / Prevention
§ Treatment / Intervention
§ Efficacy
§ Harm
Ask
Ask
Map question
n Prevention / Etiology
Soy and breast cancer prevention
Cohort studies
nTreatment / Intervention
Chromium picolinate and body weight
RCTs
Choosing the best study design to
address your question
Question)type
Example
Study)types
Appraisal)
issues
Etiology(and(
risk(factors
Are(there(
known(factors(
associated(with(
increased(risk?
Systematic(
review(of(cohort(
studies,(cohort(
studies,(case
-
control(study
Groups(only(
differ(in(the(one(
exposure,(
control(for(
confounding
Intervention
What(are(the(
outcomes(of(the(
intervention
Systematic(
review(of(RCTs,(
RCTs
Randomization,(
blinding,(
complete(
follow
-up
*Adapted(from(the(NHMRC(2000b ,(The(Endorsement(Process(for(Evidence,(
Base(Clinical(Practice(Guide lines ,(Dietitians(Association(of(Australia(2006
Are ___________________________ (P)
who have______________________ (E)
compared with those without / low__ (C)
at ____ risk for _________________ (O)
Treatment / Intervention
Prevention / Etiology
In _____________________ (P)
how does _______________ (I)
compared with ___________(C)
affect __________________ (O)
PICO Question
Prevention / Etiology
u Are ___________________________(P)
u who have______________________ (I)
u compared with those without / low___(C)
u at ____ risk for __________________(O)
u Are post-menopausal women who have a
high consumption of soy products,
compared to those with a low intake, at
decreased risk for developing breast
cancer?
PICO question
Treatment / Intervention
u In _____________________ (P)
u how does _______________ (I)
u compared with ___________(C)
u affect __________________ (O)
u In individuals who are overweight
(BMI > ? ) how does a daily
chromium picolinate supplement,
compared with no supplement, affect
ones ability to lose weight?
PEN
®
Training Modules
The following other PEN
®
Training Modules
are available:
• Evidence-based Process
• Appraising the Literature
• PubMed Module
• Quick Review of Study Designs
Thank you for your time in
reviewing this module.
Come be social with PEN
pennutrition
PENNutrition PEN Nutrition
