Article Text

Download PDFPDF
35 Online randomised controlled trial to improve clinical estimates of survival (ORACLES): study design
  1. Linda Oostendorp1,
  2. Nicola White1,
  3. Priscilla Harries2,
  4. Sarah Yardley1,3,
  5. Christopher Tomlinson1,4,
  6. Federico Ricciardi1,
  7. Hulya Gokalp2 and
  8. Patrick Stone1
  1. 1University College London, UK
  2. 2Brunel University London, UK
  3. 3Central and North West London NHS Foundation Trust, UK
  4. 4Imperial College London, UK


Introduction Clinicians often struggle to recognise whether palliative care patients are imminently dying.1 2 A previous study identified the factors that expert palliative care doctors (with demonstrated prognostic skills) had used to judge the probability of patients dying within 72 hours.

Aim and methods To evaluate whether an online training resource can teach medical students to formulate survival estimates for palliative care patients that are more similar to experts’ estimates. In this online randomised controlled trial we will recruit 128 students in the penultimate/final year of medical school. Participants are asked to review three series of vignettes describing patients referred to palliative care and provide estimates (0%–100%) about the probability that patients will die within 72 hours. After the first series of vignettes students in the intervention arm are given access to the training resource showing how experts weighted the various symptoms/signs. Participants are asked to complete a second series of vignettes and then a third series after two weeks to assess if any effect has been maintained.

Results Students’ survival estimates will be correlated with experts’ estimates to determine the baseline level of agreement and any changes following the intervention. The primary outcome will be the survival estimates provided in the second series of vignettes. Secondary outcomes include the estimates provided at the follow-up the weighting of symptoms/signs and levels of discrimination and consistency.

Conclusion This study will provide evidence about whether a brief low-cost online training resource can influence how medical students make prognostic decisions in an experimental setting.


  1. . Neuberger J. More care less pathway: A review of the liverpool care pathway.Department of Health2013. Available from: [Accessed: 30thMay 2018]

  2. . White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?PLoS One25 August 2016;11(8):e0161407. Available from: [Accessed: 30th May 2018]

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.