Locating evidence to support clinical reasoning and decision-making needs a considered approach to finding the best possible information by the health professional. This means health professionals need to develop more efficient habits to search and locate evidence. Additionally, a positive patient experience relies on attention to detail by the health professional exercising a reasoned approach to gathering and utilising information.
At times, clinicians are unclear about finding and accessing the best evidence. Added to this, health professionals do not always know how to interpret and apply the information clinically or use it in their learning. To overcome this, we review how to ask questions about patient care and subsequently how to work within the databases. We suggest that asking questions in a logical manner helps the health professional to gain confidence in their ability to access evidence and assess the worth of evidence when applying it to solve clinical problems.
In practice, clinicians are commonly time-poor, hence searching for and applying the best evidence does not always take precedence in daily work. An existing tool, PICO, allows health professionals to pose clear clinical questions that allow more successful interrogation of databases for evidence. PICO can be used on ward rounds in the clinical setting to direct the clinicians thinking toward clear concepts or wording that has more success in finding meaningful evidence for clinical queries.
PICO is an acronym for Patient or Population problem, Intervention, Comparison and Outcome(s) and remains one of the best tools to help formulate questions to locate research from which to develop critical thinking that contributes directly to clinical interventions, which enhance clinical knowledge. In our experience, clinicians often find themselves asking clinical questions that are complex and need teasing out into several PICO formulated questions. PICO is a tool to help navigate and clarify how to interrogate and ask questions of the databases once questions have been narrowed down so databases can provide specific answers.
PICO remains one of the best tools to help locate research from which to develop knowledge about clinical interventions. PICO encourages the use of words inherent in databases as, for example, Major Headings to identify specific search terms and how they are mapped and linked throughout a database. PICO encourages health professionals to practise consistent search strategies in relevant databases and clarifies that there may be multiple PICO questions that they need to be aware of for any one patient. Ultimately, it is the patient outcome driving the use of the PICO tool so as to achieve patient-centred care as better outcomes for people with ill-health, for example, prevention of stroke.
While databases allow searches using natural language (everyday language), this may limit the success of finding information online, therefore, understanding a patient problem or the desired outcomes for the patient is key. It is essential that health professionals be able to translate the ‘natural language’ PICO into language orientated to that of the database they are searching within. This means a natural language search may not transfer to the database easily with the health professional experiencing, possibly, no results at all or so many results; they may just pick the first ten results and are unable to ascertain whether results are worthwhile following up. Therefore, it becomes essential for health professionals to be familiar with the database language, headings and concepts, to optimise their success in finding the best evidence.
Starting with the primary outcome agreed on for and with the patient is the health professional needs to plan the PICO from the desired outcome which ought to reflect a solution to the primary problem. As the health professional works to identify the primary outcome, they are most likely to encounter multiple outcomes that need to be addressed and these need to be decluttered and patient-centric. Additionally, in evidence-based health care, the professional needs to question what is the desired outcome is for this person. It may not relate to the primary problem, however, is as important as this is the patient perspective that needs to be included.
In this poster, we will provide a scenario example, identify the key clinical problem. From this, we will identify multiple problems that need to be addressed that feed into the solution to achieve the desired outcome. Asking questions of a clinical scenario we will demonstrate that for one patient, there are likely to be multiple PICOs that need to be built, answered and prioritised; that the way evidence is located will contribute to the prioritisation of clinical care and interventions.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters