Cognitive Behavior Therapy

The Role Of Clinical Supervision In Cognitive Behavior Therapy

Introduction

Asking the right question is perhaps the hardest skill to learn—and yet it is fundamental to the EBDM process. A “well-built” question should include 4 parts that identify the patient problem or population (P), intervention (I), comparison (C), and outcome(s) (O), referred to as PICO. This question is often generated directly by the patient or the care being considered for that patient. However, it can also emerge from an observed problem or a topic of interest, or to explore a new material or procedure, to clarify differences, or compare cost-effectiveness in practices among associates, hygienists, and other members of the office team. The PICO-procedure is an effective way of answering clinical questions. In PICO 'P' stands for problem or patient, 'I' for intervention, 'C' for comparison and 'O' for outcome. First, the PICO-question is formulated. Next, the relevant domain (therapy/ prevention, diagnosis, etiology/risk or prognosis) is established, along with the type of research by means of which the question will have to be answered. The criteria of inclusion or exclusion are formulated, in order to determine the problem or patient-specific factors as precisely as possible. To make it possible to search professional literature files, the PICO-question then has to be converted into key words. Articles subsequently located should then be evaluated in terms of their scientific quality and usefulness for answering the question. After this procedure has been followed, an evidence-based answer can be given to the original question.

This, in turn, allows you to determine the type of evidence and information required to solve the problem and to measure the effectiveness of the intervention. In addition, you can better evaluate your effectiveness in applying the EBDM process. Thus, EBDM supports continuous quality improvements through measuring outcomes of care and self-reflection.

One of the greatest difficulties in developing each aspect of the PICO question is providing an adequate amount of information without being too detailed. It is important to stay focused on the main components that directly affect the situation. Each component of a PICO question should be specific, rather than a laundry list of everything you can think of regarding that problem or patient. Each component of the PICO question should be stated in a concise phrase.

Application of the PICO process in clinical practice is best illustrated with an example. This is the same case study that was presented in the first feature, and it will be used as we demonstrate each aspect of the evidence-based decision-making process.

Case example

The morning patient, Mrs Jennifer Morris, comes to you distressed because of an article she read on the Internet about the dangers of mercury in her amalgam restorations. She is worried that her 7 amalgam fillings are poisoning her. She is very concerned, not only for her own health but for her 2 young daughters who also have amalgam restorations. Jennifer doesn't want to replace her fillings if it isn't necessary, but she needs proof that she and her children are going to ...