Limitations
This study has limitations. First, this single–health system trial may not be generalizable to other systems. Second, our intervention’s impact on SIC and end-of-life outcomes may have been limited because it nudged time-constrained oncologists. Future machine learning–based nudges could involve specialty palliative care referral and nonclinician staff. Third, there are no established standards defining a clinically meaningful impact on end-of-life systemic therapy. However, the effect estimate for end-of-life systemic therapy compares similarly to a prior randomized evaluation of early palliative care.