OPEN ACCESS: All Research Methods & Reporting
Ten steps towards improving prognosis research
Cite this as:
BMJ
2009;339:b4184
- Harry Hemingway, professor of clinical epidemiology1,
- Richard D Riley, senior lecturer in medical statistics2,
- Douglas G Altman, professor3
- 1University College London, London WC1 6BT
- 2Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT
- 3Centre for Statistics in Medicine, Oxford
- Correspondence to: h.hemingway{at}ucl.ac.uk
- Accepted 21 August 2009
Stemming the tide of low quality, low impact, prognosis research is an urgent priority for the medical and research community. Diverting currently wasted research resources into high quality prognosis research will require major changes, one of which is the implicit collusion between researchers, medical journal editors, and conference organisers: “If you agree to inflate the importance of your research, we will agree to showcase it.” We outline challenges facing prognosis research, and possible next steps, drawing on recent evidence from different clinical specialties and study designs.
Problems with prognosis research
Prognosis research has been defined as the study of relations between occurrences of outcomes and predictors in defined populations of people with disease.1 It encompasses (ideally) prospective, observational research evaluating three broad questions—causes of disease progression, prediction of risk in individuals, and individual response to treatment. High quality prognosis research results in better understanding of disease progression, offers improved opportunities for mitigating that progression, and allows more reliable communication of outcome risk to patients.1 2 Prognosis research should be a basic science in translational medicine.
Analysing 168 reports, Malats and colleagues concluded that “after 10 years of research [including over 10 000 patients], evidence is not sufficient to conclude whether changes in P53 act as markers of outcome in patients with bladder cancer.”3 This is not an isolated example. Such concerns have been identified in systematic reviews of different types of prognostic biomarkers4 5 and across different clinical specialties and major global burdens of disease including cancer,6 coronary disease,7 stroke,8 trauma,9 and musculoskeletal disorders.10 11 Although some systematic reviews and meta-analyses of prognostic studies …
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