Capella 4030 Assessment 3

Capella 4030 Assessment 3 Picot Questions and An Evidence Based Approach

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Capella University

NURS-FPX 4030 Making Evidence-Based Decisions

Prof. Name

Date

PICO (T) Questions and an Evidence-Based Approach

Chronic Obstructive Pulmonary Disease (COPD) is a progressive and complex health condition requiring a multifaceted approach to care. This approach results in effective COPD management and positive patient outcomes if integrated with credible evidence. While exploring further, this assessment focuses on a PICO(T) question related to the disease and credible and relevant evidence that helps answer the inquiry. Lastly, based on these evidence-based findings, we conclude a decision for our PICO(T) question elaborated in this paper. 

Practice Issue to be Explored and PICO(T) Question

COPD is a chronic inflammatory lung disease characterized by persistent airway restriction. Two conditions typically emerge due to constant airflow limitations: chronic bronchitis and emphysema. Several factors contribute to the development of the diseases, including smoking, environmental exposure to pollutants (such as secondhand smoke, occupational dust, and chemicals), genetic predisposition, and respiratory infections (Yan et al., 2020). Among these, smoking is the primary and substantial risk factor, accounting for 15.2% of cases in individuals who are currently smoking and 7.6% in past smokers. Prolonged exposure to cigarette smoke damages the respiratory pathways, leading to inflammation, narrowing of the airways, and destruction of lung tissue (Wheaton et al., 2019). Smoking cessation is the most effective intervention to prevent COPD and its complications. Through a PICO(T) approach, we aim to explore the effectiveness of smoking cessation among smoking individuals diagnosed with COPD. 

PICO(T) Inquiry

Among smokers with early-stage COPD (P), does combined smoking cessation interventions (behavioral and pharmacological options) (I) compared to standard care (C) reduce the risk of disease progression and exacerbations (O)? 

Benefit of PICO(T) Approach

A PICO(T) approach offers a structured framework for formulating focused research questions and guiding evidence-based inquiry (Hosseini et al., 2024). Exploring the effectiveness of smoking cessation as compared to medication management in COPD patients through the PICO(T) approach will enable healthcare professionals to conduct a systematic review of the existing evidence, identify the gaps in knowledge, and evaluate the evidence to make informed decisions (Hosseini et al., 2024). Additionally, the approach will facilitate the application of credible findings to clinical practice, informing individualized treatment strategies and public health interventions aimed at reducing the COPD burden associated with smoking. Moreover, employing a PICO(T) approach enhances the applicability of research on COPD and smoking, ultimately improving patient outcomes and advancing healthcare practice. 

Identification of Sources of Evidence

Based on the eligibility criteria, several resources are identified that can potentially answer the PICO(T) question. The requirements include relevance, currency, scope and coverage, methodological rigor, and applicability. 

• Relevance: The resources should contain relevant information to the PICO(T) question (Dagne & Beshah, 2021). In this case, the sources of information focus on best practices and interventions related to COPD. 
• Currency: The resources should provide up-to-date evidence, including recent research studies, systematic reviews, and guidelines, to ensure the information is current and applicable to contemporary healthcare practice (Tawfik et al., 2019). 
• Scope and Coverage: The resources should cover a broad range of relevant topics related to the topic (Hosseini et al., 2024), such as COPD management, smoking cessation interventions, pharmacotherapy options, and long-term outcomes, ensuring comprehensive coverage of the research question.
• Methodological Rigor: Research studies and systematic reviews should demonstrate the rigorous methodology, including appropriate study designs, sample sizes, statistical analysis, and risk of bias assessment, to ensure the reliability and validity of the findings (Tawfik et al., 2019). 
• Applicability: The resources should provide information that applies to clinical practice, guiding healthcare providers in making evidence-based decisions (Dagne & Beshah, 2021), for example, regarding smoking cessation interventions and COPD management strategies for patients with early-stage COPD.

Capella 4030 Assessment 3

To effectively answer the PICO(T) question regarding smoking cessation intervention as compared to pharmacotherapy in COPD patients, several sources of evidence can be utilized. These include databases like PubMed and Cochrane Library. PubMed is a comprehensive database containing many peer-reviewed articles and systematic reviews relevant to COPD management and smoking cessation interventions (Ossom Williamson & Minter, 2019). Similarly, the Cochrane Library specializes in systematic reviews and evidence synthesis, providing high-quality, up-to-date reviews on the effectiveness of various diseases and their interventions, including smoking cessation strategies and their impact on COPD outcomes.

Moreover, a peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine (AJRCCM) can be utilized to identify research articles and reviews on respiratory diseases, including COPD and smoking cessation interventions. Lastly, the American Thoracic Society (ATS) Website offers guidelines, position statements, and resources related to respiratory diseases and smoking cessation, representing a reputable source of evidence-based information and its relevance to our PICO(T) inquiry (American Thoracic Society, n.d.). These sources effectively answer the PICO(T) question based on the criteria presented earlier. 

Findings from the Relevant Sources of Evidence

Several findings are relevant to the PICO question about smoking cessation in comparison with standard care. 

• A research article presented in the PubMed database by Andreas et al. (2023) mentions the importance of smoking abstinence to improve outcomes for COPD patients. The article emphasizes the effectiveness of smoking cessation therapy, including a combination of behavioral and pharmacological interventions (treating withdrawal symptoms), to alleviate the risk of COPD progression and reduce healthcare costs. 
• Galiatsatos et al. (2021) present a clinical guideline by ATS, highlighting the efficacy of integrated smoking cessation and medication management for tobacco-dependent individuals, including COPD patients who are currently habitual of smoking. This practice guideline focuses on the effectiveness of pharmacologic treatment as part of comprehensive smoking cessation interventions, including the use of medications such as nicotine replacement therapy (NRT), bupropion, and varenicline. The findings of this resource are that these interventions reduced the decline in lung function and alleviated the risk of exacerbations and disease progression, making them the most credible for PICO(T) inquiry. 

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• Another article by Tsikrika et al. (2023) underscores the efficacy of combination smoking cessation therapy. The findings from this study are that quitting smoking can improve COPD conditions, reduce the risk of mortality, and improve lung function. However, it is only possible if behavioral and pharmacotherapy interventions are employed together. This article also highlights that some authors still focus on the effectiveness of standard care, such as pulmonary rehab and bronchodilators. Yet, advances in research focus on smoking cessation through combined efforts as they have promising outcomes for elevating smoking abstinence. This resource is highly credible as it provides relevant and up-to-date information. Moreover, it fulfills the criteria of credibility and relevance, as mentioned earlier. 

Decision-Making on PICO Question Using the Findings

Based on the findings from the literature, it is evident that combined smoking cessation interventions, encompassing both behavioral and pharmacological options, offer significant benefits in reducing the risk of disease progression and exacerbations among smokers with early-stage COPD. The most relevant findings are from the studies by Galiatsatos et al. (2021) and Tsikrika et al. (2023). These articles specifically guide healthcare professionals about the pharmacotherapy options that can improve patient health, reduce the risk of disease progression, decrease healthcare costs, and improve lung function.

Behavioral interventions, such as counseling and support programs, combined with pharmacological options like nicotine replacement therapy and medications such as varenicline, have been shown to promote smoking cessation and improve COPD outcomes effectively. Thus, the decision on our PICO(T) inquiry is to use combined smoking cessation to improve patient health, reduce the risk of disease progression, decrease healthcare costs, and improve lung function. While some studies still focus on standard care interventions such as pulmonary rehabilitation and bronchodilators, recent advances and evidence-based practices underscore the critical importance of smoking cessation in COPD management. Therefore, smoking cessation interventions should be prioritized in the management of smokers with early-stage COPD to reduce disease progression and exacerbations.  

References

American Thoracic Society. (n.d.). Ats website. https://www.thoracic.org/about/governance/ats-website/index.php

Andreas, S., Kotz, D., Batra, A., Hellmann, A., Mühlig, S., Nowak, D., Schultz, K., Worth, H., & Schüler, S. (2023). Smoking cessation in patients with COPD. Pneumologie (Stuttgart, Germany), 77(4), 206–219. https://doi.org/10.1055/a-2020-4284 

Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PLoS ONE, 16(8), e0256600. https://doi.org/10.1371/journal.pone.0256600

Capella 4030 Assessment 3

Galiatsatos, P., Garfield, J., Melzer, A. C., Leone, F. T., Farber, H. J., Ruminjo, J. K., & Thomson, C. C. (2021). Summary for clinicians: An ATS clinical practice guideline for initiating pharmacologic treatment in tobacco-dependent adults. Annals of the American Thoracic Society, 18(2), 187–190. https://doi.org/10.1513/AnnalsATS.202008-971CME 

Hosseini, M.-S., Jahanshahlou, F., Akbarzadeh, M. A., Zarei, M., & Vaez-Gharamaleki, Y. (2024). Formulating research questions for evidence-based studies. Journal of Medicine, Surgery, and Public Health, 2, 100046. https://doi.org/10.1016/j.glmedi.2023.100046

Ossom Williamson, P., & Minter, C. I. J. (2019). Exploring PubMed as a reliable resource for scholarly communications services. Journal of the Medical Library Association : JMLA, 107(1), 16–29. https://doi.org/10.5195/jmla.2019.433 

Tawfik, G. M., Dila, K. A. S., Mohamed, M. Y. F., Tam, D. N. H., Kien, N. D., Ahmed, A. M., & Huy, N. T. (2019). A step by step guide for conducting a systematic review and meta-analysis with simulation data. Tropical Medicine and Health, 47(1), 46. https://doi.org/10.1186/s41182-019-0165-6

Capella 4030 Assessment 3

Tsikrika, S., Dai, S., Dilektasli, A., Katsaounou, P., & Dagli, E. (2023). Challenges and perspectives of tobacco cessation in special groups of patients and populations. Breathe, 19(2), 220224. https://doi.org/10.1183/20734735.0224-2022 

Wheaton, A. G., Liu, Y., Croft, J. B., VanFrank, B., Croxton, T. L., Punturieri, A., Postow, L., & Greenlund, K. J. (2019). Chronic obstructive pulmonary disease and smoking status—United States, 2017. Morbidity and Mortality Weekly Report, 68(24), 533–538. https://doi.org/10.15585/mmwr.mm6824a1 

Yan, X., Xu, L., Shi, B., Wang, H., Xu, X., & Xu, G. (2020). Epidemiology and risk factors of chronic obstructive pulmonary disease in Suzhou: A population-based cross-sectional study. Journal of Thoracic Disease, 12(10), 5347–5356. https://doi.org/10.21037/jtd-20-1616