Chris Coleman is yet to strike upon a system and team capable of stringing together the wins Sunderland need to survive.
Defeat at QPR was Sunderland’s ninth without a win to leave them on the brink of League One football next season.
Sunderland are rock bottom and, with just nine games left to save themselves, realistically Coleman will have to win at least half of them, probably more, to survive.
Preston North End remain in the hunt for a play-off spot and will provide another stern test at the Stadium of Light, the scene of just two home wins all season.
We examine the burning issues facing Coleman ahead of the game:
To keep faith with Ashley Fletcher?
Coleman will have spent part of this week trying to boost Fletcher’s confidence after the struggling Middlesbrough loanee was jeered off at Loftus Road.
Seven games in, he is yet to score. What makes it worse is that one of Sunderland’s other deadline day targets, Swansea City striker Oli McBurnie, has scored six times since joining relegation rivals Barnsley on loan.
Coleman has put a lot of faith in Fletcher with other options limited. But he is struggling badly.
Should Kazenga LuaLua ever shake off his ankle injury, he would play through the middle, but, in the meantime, Coleman will be weighing up whether to keep faith with Fletcher or play Josh Maja through the middle, or play the pair together, with livewire Joel Asoro the other option.
Verdict: Time is almost up, Sunderland need to win and go two up top with Maja alongside Fletcher, with support from Joel Asoro.
To take a risk in goal?
Sunderland have dropped goalkeepers five times and Coleman will be forced into a sixth change against Preston, with Jason Steele serving a one-game ban.
Steele’s howler at Loftus Road opens the door for Lee Camp to return.
Camp made a couple of good saves against QPR, but he remains unconvincing on crosses, with Sunderland’s ongoing struggles defending set pieces a major issue.
With Robbin Ruiter out with a badly dislocated finger, Coleman has few other options than to play January signing Camp, who joined from Cardiff City.
Coleman, however, could take a big risk and play Under-23 stopper Max Stryjek.
The 21-year-old was recalled in January from a disappointing loan at League Two side Accrington Stanley and is currently third choice behind Steele and Camp.
Verdict: It would be a massive surprise for Coleman to start Stryjek. While Sunderland’s fate remains in the balance, he is likely to opt for experience in Camp.
Switch system – again?
With injuries forcing his hand, Coleman started with a flat-back four at QPR, with Ty Browning out for the season and Jake Clarke-Salter completing his three-match ban.
The Chelsea loanee is available to face Preston, with Coleman weighing up whether to revert to five at the back, with Clarke-Salter joining John O’Shea, playing through the pain barrier, and Lamine Kone.
George Honeyman, Ovie Ejaria and Joel Asoro provided the few plus points from QPR and Coleman will be keen to keep them in the side, with Lee Cattermole sitting deep.
With Aiden McGeady and Callum McManaman not consistent enough, they are likely to start on the bench.
There’s plenty to ponder, but at least Coleman has options for a game Sunderland simply MUST win.
Verdict: Stick with four at the back to allow an attacking player to remain in the side.