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PICO(T) Questions and an Evidence-Based Approach
Elyse Stevens
Capella University
NHS – FPX 4030 Making Evidence-Based Decisions
Annette Kennedy
January 3, 2024
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Using a PICO(T) Framework and Evidence to Develop Care Practices
Research that is grounded in evidence is crucial to nursing. Nurses may deliver effective and efficient patient care by creating a patient plan centered around the PICO(T) technique. PICO(T) inquiries center on population, intervention, comparison, outcome, and time, and they are a search method that produces an objective and successful search (Gallagher & Melnyk, 2019). Key phrases will be employed to generate the most critical evidence for evidence-based research. The PICO(T) approach yields dependable evidence-based practice and a quick and efficient search. In order to guarantee optimal decision-making, improve patient outcomes, and provide treatment (Gallagher & Melnyk, 2019). A nurse can quickly determine which interventions can improve their patient's outcomes by applying the PICO(T) technique.
Use of the PICO(T) Approach in Patients with End-stage Renal Disease
The impact of early detection of depression and anxiety on medication compliance for patients with end-stage renal disease (ESRD) is the topic to be investigated using PICO(T). The inquiry to be investigated is: in comparison to not having depression and anxiety diagnosed and treated, what impact does having them identified and treated have on long-term treatment compliance in individuals with ESRD?
Anxiety and depression are common among those with end-stage renal disease (ESRD), which lowers their quality of life. Although they have not been thoroughly researched in patients with this illness, psychological therapies can help lessen these symptoms. Individuals with ESRD
who also suffer from depression are more likely to forego ESRD treatment (Horiba et al., 2022). This assessment aims to determine whether early detection and treatment of this chronic illness will improve long-term treatment compliance.
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Identification of Sources of Evidence
In the first article, Kondo et al. investigated depression screening instruments for kidney failure patients. Even though ESRD patients must undergo routine depression screenings, the Centers for Medicare and Medicaid Services still lack clear guidelines for carrying out this process. The study conducted for this paper examined several features of the clinical depression assessment instruments utilized with kidney disease patients. According to their findings, the best
tool was the Beck Depression Scale II. The Health Questionnaire 9 and the Depression Scale 15, two other popular public domain instruments not examined, performed well. Brief screening instruments, such as those created by Beck Depression, might be the best choice for preliminary assessment. (Kondo et al., 2020).
González-Flores et al. investigated the impact of the resilience model and cognitive behavioral intervention on the symptoms of sadness and anxiety in hemodialysis patients in a different paper. Analyzing the impact of the two interventions on the quality of life and depressive symptoms in ESRD patients was the study's primary goal (González-Flores et al., 2023).
Lastly, Robiner et al. investigated the relationship between medication adherence and depression in kidney transplant applicants' and recipients' quality of life. Depression is a common occurrence among people with ESRD, which can reduce their quality of life. Additional
issues like increased weight gain and phosphorus levels before dialysis could also arise. Depression is associated with an increased risk of death in hemodialysis users. Depression examinations are now mandated for all adult patients in the United States due to the severe nature of these disorders and the association between depression complications and significant financial and psychological consequences. (Robiner et al, 2022).
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Findings from Articles
There is currently little data on the efficacy of depression screening instruments in patients with renal illness, according to the publication "Depression Screening Tools for Patients with Kidney Failure: A Systematic Review." The caliber of the reporting and methodology contributes to some of the research's weaknesses. Future research should concentrate on commonly used, free tools. The validity of depression screening instruments needs to be established because there is no universally accepted method for evaluating their efficacy despite the wide variety of tools available. The goal of the study was to find depression screening techniques that are suitable for people with kidney disease (Kondo et al., 2020).
Participants were split into two groups at random for the paper "Effect of Cognitive Behavioral Intervention Combined with the Resilience Model to Decrease Depression and Anxiety Symptoms and Increase the Quality of Life in ESRD Patients Treated with Hemodialysis." Cognitive behavioral treatment techniques were administered to the first group, and resilience model interventions were added to the regimen for the second group. Various psychological instruments were used, including the Quality of Life Questionnaire, the Mexican Resilience Scale, and the Beck Depression Inventory. The participants were assessed eight weeks
prior to treatment, eight weeks throughout treatment, and four weeks following the intervention, among other times during the program. According to their findings, the intervention group showed improved resilience qualities along with reduced levels of both somatic and overall depression. In the evaluation periods, the control group performed worse than the other groups (González-Flores et al., 2023).
Providing quantitative measurements of medication adherence at two-point intervals during the transplant process was the aim of the article "Depression, Quantified Medication
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Adherence, and Quality of Life in Renal Transplant Candidates and Recipients." This differs from earlier research conducted by others that depended on patient self-reporting. Unlike cross-
sectional research, it is prospective and does not compare two patient groups. Instead, it centers on the patients' longitudinal state. The study's findings showed that applicants and recipients of kidney transplants differ significantly in terms of their degrees of depression and medication adherence. Patients with end-stage renal disease (ESRD) reported variable quality of life and depressed symptoms, which are likely related to their disease and associated comorbidities. They
also showed inconsistent patterns of adherence to their prescribed drug schedules. Only a tiny percentage of them continue to take their prescriptions according to their prescribed regimens, even though many attain satisfactory adherence. This implies that to make sure that patients are taking their medications according to their prescribed schedules, more regular and systematic assessments of adherence are required. The team knew going into the transplant that because immunosuppression was required, there would be a higher level of adherence following the procedure.
Nevertheless, it is unclear why this expectation was not fulfilled. To reduce side effects, some patients may have started to stop taking their drugs. Post-transplant patients may no longer be as focused on time and medication due to changes in their lifestyles, which could lead to less accurate and consistent drug schedules. It might concern patients' innate propensity to stop adhering (Robiner et al., 2022).
Relevance of Findings from Articles
The findings highlight the significance of screening for depression and other mental health issues in transplant recipients and those with end-stage renal disease (ESRD). If the
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condition is identified, then the benefits of this surgery are probably attained. According to the results, people who are not thought to be at a high risk of developing depression might benefit from monitoring in order to improve their quality of life and avoid negative consequences. More research is necessary to determine the relationship between these findings and clinical outcomes precisely. Primary care practices now routinely screen for depression, which may be an example of how to treat this problem in patients with end-stage renal disease (ESRD) and transplant recipients.
Psychological therapy techniques with sick patients may enhance their quality of life and directly impact their medical expenses. Following an ESRD diagnosis, improvements in quality of life are typically linked to different aspects of the illness. Several studies have found a correlation between depression and life quality. A low standard of living is a sign of depression. A patient with end-stage renal disease (ESRD) has a better chance of improving their quality of life if treatment for depression is started early.
Conclusion
Few studies focus on depression concerning end-stage renal disease and how to make an accurate and early diagnosis. Some more invasive methods of treating the illness are administered to the patient. To provide patients the best opportunity to achieve the best possible outcomes throughout their lives, more research is needed to establish the gold standard for treating depression concurrently with end-stage renal disease.
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References
Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process.
Worldviews on Evidence-Based Nursing
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(6), 422–423. https://doi-org.library.capella.edu/10.1111/wvn.12408
González-Flores, C. J., Garcia-Garcia, G., Lerma, C., Guzmán-Saldaña, R. M. E., & Lerma, A. (2023). Effect of Cognitive Behavioral Intervention Combined with the Resilience Model
to Decrease Depression and Anxiety Symptoms and Increase the Quality of Life in ESRD
Patients Treated with Hemodialysis.
International journal of environmental research and public health
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(11), 5981. https://doi.org/10.3390/ijerph20115981
Horiba, Y., Ishizawa, K., Takasaki, K., Miura, J., & Babazono, T. (2022). Effect of depression on progression to end-stage renal disease or pre-end-stage renal disease death in advanced diabetic nephropathy: A prospective cohort study of the Diabetes Study from the Center of Tokyo Women's Medical University.
Journal of diabetes investigation
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(1), 94–101. https://doi.org/10.1111/jdi.13620
Kondo, K., Antick, J. R., Ayers, C. K., Kansagara, D., & Chopra, P. (2020). Depression Screening Tools for Patients with Kidney Failure: A Systematic Review.
Clinical Journal of the American Society of Nephrology: CJASN
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(12), 1785–1795. https://doi.org/10.2215/CJN.05540420
Robiner, W. N., Petrik, M. L., Flaherty, N., Fossum, T. A., Freese, R. L., & Nevins, T. E. (2022). Depression, Quantified Medication Adherence, and Quality of Life in Renal Transplant Candidates and Recipients.
Journal of Clinical Psychology in Medical Settings, 29
(1), 168–184. https://doi.org/10.1007/s10880-021-09792-2