Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice


In general, PICOT may be defined as a specific acronym used in nursing that is traditionally applied for the creation of a clinical question to direct the health care provider’s search for reliable evidence. An appropriately devised PICOT question is highly significant as it establishes the process of research and facilitates the development of its results. At the same time, a poorly formulated research question may have a negative impact on the study’s findings and lead to futility and their insignificance. The model of PICOT is a framework for the evaluation of various aspects of the investigation (Lira & Rocha, 2019). It is an essential and relevant part of any high-quality evidence-based research that may significantly contribute to the development of efficient health care delivery in nursing practice.

In a clinical trial, the PICOT question should include the following components:

  • Population (P) – “to cite the eligibility criteria for participants and report the settings and locations in addition to where the data were collected” (Lira & Rocha, 2019, p. 5). In addition, this element may refer to the problem of research as well. That is why the question for the component of population and problem is “what is the nursing practice concern or problem and whom does it affect?”;
  • Intervention (I) – to describe the interventions for a defined population with sufficient details that provide an opportunity for the development of another solution. The component of intervention answers the question, “What evidence-based solution for the problem may a nurse practitioner apply?”;
  • Comparison (C) – to define alternatives. As appropriate research includes multiple options, the element of comparison in the PICOT format should focus on another potential solution for the defined problem;
  • Outcome (O) – to define pre-specified outcome measures to the full extent to justify the efficiency of the intervention;
  • Time (T) – to define the intervention’s completion date or the timeframe of the intervention.

Practical Application of the PICOT Question

In the present day, diabetes remains a serious chronic disease all over the world that has considerably severe complications. Despite the fact that the general rates of cardiovascular events are currently declining, they still may be regarded as the primary cause of morbidity and mortality in patients who suffer from diabetes (Kruger, 2018). In general, cardiovascular complications related to diabetes traditionally include heart failure, cerebrovascular disease, coronary heart disease, and peripheral vascular disease (Kruger, 2018). According to multiple researches, the use of low-dose aspirin daily is a highly beneficial practice for the prevention of all types of diabetes-initiated cardiovascular disease.

Aspirin is regarded as an accessible and efficient prophylactic medication for primary and secondary prevention of cardiovascular events for patients with severe chronic diseases. In addition, women are traditionally more vulnerable to cardiovascular complications in comparison with men (National Institute of Nursing Research, n.d.). According to the results of the study conducted by the National Institute of Nursing Research, stroke, heart attacks, heart failure, atherosclerosis, high blood pressure, and coronary artery disease are the most frequent causes of death for American women (National Institute of Nursing Research, n.d.). The risk of cardiovascular events for female patients with diabetes is more substantial.

That is why, for the investigation of the impact of aspirin on the prevention of heart attacks, coronary heart disease, or stroke on patients with diabetes, it is essential to consider their gender for more reliable evidence and results. In general, the examination of this problem based on appropriately formulated PICOT question may positively affect nursing practice as it will provide specific recommendations for health care specialists to reduce the number of women’s cardiovascular incidents. On the other hand, the ignorance of this disturbing health care issue will inevitably result in increased death rates.

Based on the defined problem, the clinical question will include the following components:

  • P = Women with diabetes is defined as the target population for the research;
  • I = The usage of low-dose aspirin daily is defined as a basic intervention;
  • C = No usage of low-dose aspirin is an alternative to the defined intervention;
  • O =The preferable outcome of the intervention is to reduce the risk of cardiovascular events;
  • T = The accurate timeframe of the intervention is not defined, however, the defined intervention may take several years for reliable results.

PICOT question written in full = For women with diabetes (P), does the use of low-dose aspirin daily (I) reduce the risk of cardiovascular events (O) within several years (T) in comparison with no usage of low-dose aspirin (C)?

A substantial number of comprehensive and well-elaborated researches is dedicated to the effect of acetylsalicylic acid, or aspirin, on the prevention of various cardiovascular events in patients with diabetes. Capodanno and Angiolillo (2016) investigated the aspirin’s antithrombotic potential to prevent nonfatal myocardial infarction, ischemic stroke, and other cardiovascular problems associated with diabetes. In addition, similar to other scholars, the authors focused on the examination of medication’s value for both primary and secondary prevention. According to the study’s results, the benefit of aspirin’s use for primary prevention of cardiovascular events is highly controversial (Capodanno & Angiolillo, 2016). The research conducted by Raber, et al. (2019) supported the findings of Capodanno and Angiolillo (2016). While aspirin reduces the risk of myocardial infarction and stroke as primary cardiovascular disease prevention, it increases the risk of intracranial and gastrointestinal bleeding (Raber et al., 2019). At the same time, the advantages of the aspirin’s usage for secondary prevention “have been repeatedly and convincingly demonstrated to outweigh the risk of bleeding” (Capodanno & Angiolillo, 2016, p. 1579).

In relation to the effect of the patient’s sex, the efficiency of aspirin for the prevention of cardiovascular disease is proved both for male and female patients with diabetes. However, it is reportedly more beneficial for the reduction of cardiovascular accidents in men and stroke in women (Capodanno & Angiolillo, 2016). In general, according to Raber, et al. (2019), the women’s health study (WHS) had demonstrated the advantages of acetylsalicylic acid for women based on the data received from 39876 women participated in the research. In general, concerning the formulated PICOT question, it is possible to conclude, as an answer, that for women with diabetes (P), the use of low-dose aspirin daily (I) helps to reduce the risk of cardiovascular events (O) within several years (T) in comparison with no usage of low-dose aspirin (C). However, the potential risk of bleeding should be considered, as well.


Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation, 134(20), 1579-1594.

Kruger, D. (2018). Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective. Journal of the American Association of Nurse Practitioners, 30, 43-52.

Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros de Oftalmologia, 82(2), 5. Web.

National Institute of Nursing Research. (n.d.). Subtle and dangerous: Symptoms of heart disease in women [PDF document]. Web.

Raber, I., McCarthy, C. P., Vaduganathan, M., Bhatt, D. L., Wood, D. A., Cleland, J. G. F., Blumenthal, R. S., & McEvoy, J. W. (2019). The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet, 393, 2155-2167.

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"Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice." NursingBird, 6 Jan. 2023,


NursingBird. (2023) 'Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice'. 6 January.


NursingBird. 2023. "Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice." January 6, 2023.

1. NursingBird. "Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice." January 6, 2023.


NursingBird. "Problem-Intervention-Comparison-Outcome-Time Format for Evidence-Based Nursing Practice." January 6, 2023.