Table 3.

Recommendations for future prognostication research.

Theme		Potential strategies	Examples of study design, methods and contents
1.	Enhance prognostic accuracy	Increase the number of variables	Inclusion of more variables at one point
			Use of time trend
		Identify novel prognostic factors	Phase angle
			Physical signs of impending death
		Utilize advanced statistical models	Machine learning
			Fractional polynomial model
2.	Improve reliability and reproducibility	Use objective variables only	Laboratory values and/or vital signs
3.	Identify the appropriate prognostic tool for the setting	Explore the clinical utility of prognostic tools, balancing sensitivity vs. specificity	Mapping the accuracy of different prognostic tools in different settings
		Balancing feasibility vs. accuracy, depending on clinical scenario	Qualitative interview with clinicians on how prognostic tools with different psychometric features have been useful in various clinical settings
4.	Predict the risks and benefits of cancer therapies	Identify variables that inform risk of grade 3–4 toxicity	Treatment-related factors, patient age and reserve, novel biomarkers
5.	Predict survival for pediatric populations	Use objective variables	Laboratory values and/or body weight
		Develop large databases or individual patient data	Project:EveryChild
6.	Translate knowledge to practice	Educate trainees, junior faculty	Assessment of knowledge, prognostic accuracy, attitudes and beliefs before and after training
		Develop web-based tools to facilitate calculations	www.predictsurvival.com
		Utilize graphical presentation of prognostic information	Qualitative interview with patients and families on effect of visual/graphic information on prognostic
		Assess impact of prognostication	understanding
			Assess patient outcomes and cost
7.	Understand the impact of prognostic uncertainty	Identify optimal approaches to improve prognostic confidence and address prognostic uncertainty	Improve accuracy of current prognostic tools
			Use of multiple prognostic tools
			Use of time ranges (e.g. best and worst case scenarios) instead of specific numbers when communicating prognosis
8.	Communicate prognosis	Clarify the effects of different verbal and nonverbal communication skills in providing prognostic information	Randomized video-vignette studies to evaluate the effects of various verbal and non-verbal communication skills on short-term outcomes (e.g., uncertainty, anxiety, self-efficacy, satisfaction, trust in physician, perception of physician compassion, and willingness to discuss ACP)
9.	Clarify outcomes associated with delivery of prognostic information	Clarify if accurate estimation and effective communication of prognosis improve long-term patient (true) outcomes	A cluster RCT to clarify the effects of routine provision to oncologists of EHR-generated prognostication utilizing most recent data with general ACP suggestions on long-term outcomes (e.g., quality of care and health care utilization)
10.	Standardize prognostic terminology	International congress to establish consensus definitions	Publication of standardized definitions for common terminology Define prognostic terms clearly when they are used
		Standardized statistical techniques	AUC, C-index to describe accuracy

Abbreviations: ACP, advance care planning; AUC, area under the curve; EHR, electronic health record; RCT, randomized controlled trial.