Cited by 460Meta-analysis and systematic reviewsDelphi Technique in ResearchStatistical Methods in Clinical Trials

The DOI matches its Crossref record; 50 of the 50 references it cites were found in a registry or an index; none of the 26 sources its claims cite is checked for support yet.

SPIRIT 2025 statement: updated guideline for protocols of randomised trials

Open access

Abstract

Importance: The protocol of a randomised trial is the foundation for study planning, conduct, reporting, and external review. However, trial protocols vary in their completeness and often do not address key elements of design and conduct. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was first published in 2013 as guidance to improve the completeness of trial protocols. Periodic updates incorporating the latest evidence and best practices are needed to ensure that the guidance remains relevant to users. Objective: To systematically update the SPIRIT recommendations for minimum items to address in the protocol of a randomised trial. Design: We completed a scoping review and developed a project specific database of empirical and theoretical evidence to generate a list of potential changes to the SPIRIT 2013 checklist. The list was enriched with recommendations provided by lead authors of existing SPIRIT/CONSORT (Consolidated Standards of Reporting Trials) extensions (Harms, Outcomes, Non-pharmacological Treatment) and other reporting guidelines (TIDieR). The potential modifications were rated in a three-round Delphi survey followed by a consensus meeting. Findings: Overall, 317 individuals participated in the Delphi consensus process and 30 experts attended the consensus meeting. The process led to the addition of two new protocol items, revision to five items, deletion/merger of five items, and integration of key items from other relevant reporting guidelines. Notable changes include a new open science section, additional emphasis on the assessment of harms and description of interventions and comparators, and a new item on how patients and the public will be involved in trial design, conduct, and reporting. The updated SPIRIT 2025 statement consists of an evidence based checklist of 34 minimum items to address in a trial protocol, along with a diagram illustrating the schedule of enrolment, interventions, and assessments for trial participants. To facilitate implementation, we also developed an expanded version of the SPIRIT 2025 checklist and an accompanying explanation and elaboration document. Conclusions and relevance: Widespread endorsement and adherence to the updated SPIRIT 2025 statement have the potential to enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, funders, research ethics committees, journals, trial registries, policymakers, regulators, and other reviewers.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

SPIRIT 2025 is an updated evidence-based guideline for minimum items to address in randomised trial protocols, replacing SPIRIT 2013. It provides a 34-item checklist, a schedule-of-assessments diagram, and expanded explanation and elaboration materials.

Key findings

  • The updated SPIRIT 2025 statement consists of a checklist of 34 minimum protocol items plus a diagram illustrating the schedule of enrolment, interventions, and assessments.
  • The update process involved 317 Delphi participants and 30 experts at a consensus meeting; it led to two new protocol items, revision of five items, deletion/merger of five items, and integration of key items from other reporting guidelines.
  • Notable changes include a new open science section, greater emphasis on harms and on describing interventions/comparators, and a new item on patient and public involvement in trial design, conduct, and reporting.
  • SPIRIT 2025 supersedes SPIRIT 2013, which “should no longer be used or cited.”

Methods

  • The authors conducted a scoping review of literature from 2013 to 2022 and a broader search for empirical and theoretical evidence from 2013 to 2024, producing the SPIRIT-CONSORT Evidence Bibliographic database; this was enriched with recommendations from SPIRIT/CONSORT extensions (Harms, Outcomes, Non-pharmacological Treatment) and TIDieR, plus user feedback.
  • Potential modifications were rated in a three-round international online Delphi survey with 317 participants; high agreement was defined as at least 80% of respondents rating importance as high (4 or 5) or low (1 or 2).
  • A two-day online consensus meeting in March 2023 was attended by 30 invited international experts; the executive group then drafted and finalised the checklist after further review.

Limitations

  • The paper states that SPIRIT 2025 is a minimum standard focused on the most common two-group parallel randomised trial and may not encompass every protocol item relevant for a particular trial; factorial trials and trials evaluating patient-reported outcomes have additional considerations.
  • The paper states that existing SPIRIT extensions should continue to be used until a process aligns them with SPIRIT 2025.
  • The paper states that SPIRIT 2025 is intended to promote transparency and description of what is planned, not to prescribe trial design or conduct, and should not be used to appraise trial quality; it also does not focus on protocol format.
  • Evident from the text: no prospective evaluation of SPIRIT 2025’s effect on protocol completeness or trial outcomes is reported; potential impacts are described as potential, with prior evidence cited mainly for SPIRIT 2013.

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Integrity signals

Registry

Crossref · 10.1136/bmj-2024-081477

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig 1 SPIRIT 2025 diagram of the schedule of enrolment, interventions, and assessments. Recommended content can be displayed using various schematic formats. *List target time points and acceptable time windows in this row (eg, 30±3 days). †Arrow indicates continuous delivery of intervention (eg, drug). ‡Example illustrates delivery of comparator at discrete time points (eg, psychotherapy)
Fig 1 SPIRIT 2025 diagram of the schedule of enrolment, interventions, and assessments. Recommended content can be displayed using various schematic formats. *List target time points and acceptable time windows in this row (eg, 30±3 days). †Arrow indicates continuous delivery of intervention (eg, drug). ‡Example illustrates delivery of comparator at discrete time points (eg, psychotherapy)CC BY · PubMed Central

Verification

Claims the paper makes

18 Not checked yet · 16 Own interpretation · 5 Own result · 4 No basis given

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Show all 7 claims

  • Probably not a substantial claim. 32
  • It may state two separate claims as one. 17
36 of 36
  • The paper relies on this without support.

    A complete, transparent, and accessible protocol is critical for the planning, conduct, reporting, and external review of randomised trials.

    “The protocol of a randomised trial is the foundation for study planning, conduct, reporting, and external review.”
    “A complete, transparent, and accessible protocol is critical for the planning, conduct, reporting, and external review of randomised trials”
  • The paper relies on this without support.

    The SPIRIT 2013 and CONSORT 2010 statements were conceptually linked with overlapping content and implementation strategies.

    “As the SPIRIT 2013 and CONSORT 2010 statements were conceptually linked with overlapping content and implementation strategies, the two groups decided to merge into the joint SPIRIT-CONSORT executive group and to update both checklists simultaneously.”
  • The paper relies on this without support.

    Better protocols can help study personnel to implement the trial consistently across sites.

    “Better protocols can also help study personnel to implement the trial consistently across sites.”
  • The paper relies on this without support.

    High quality protocols provide important information about trial methods and conduct that is usually not available in trial registries or publications reporting completed trials.

    “High quality protocols provide important information about trial methods and conduct that is usually not available in trial registries or publications reporting completed trials.”
4 of 4

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Metadata

Authors
Chan, A.-W., Boutron, I., Hopewell, S., Moher, D., Schulz, K. F., Collins, G. S., Tunn, R., Aggarwal, R., Berkwits, M., Berlin, J. A., Bhandari, N., Butcher, N. J., Campbell, M. K., Chidebe, R. C. W., Elbourne, D. R., Farmer, A. J., Fergusson, D. A., Golub, R. M., Goodman, S. N., Hoffmann, T. C., Ioannidis, J. P. A., Kahan, B. C., Knowles, R. L., Lamb, S. E., Lewis, S., Loder, E., Offringa, M., Ravaud, P., Richards, D. P., Rockhold, F. W., Schriger, D. L., Siegfried, N. L., Staniszewska, S., Taylor, R. S., Thabane, L., Torgerson, D. J., Vohra, S., White, I. R., & Hróbjartsson, A.
Affiliations
  • University of Toronto (CA)
  • Inserm (FR)
  • University of Oxford (GB)
  • Ottawa Hospital Research Institute (CA)
  • University of North Carolina at Chapel Hill (US)
  • UK EQUATOR Centre, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  • Jawaharlal Institute of Post Graduate Medical Education and Research (IN)
  • Centers for Disease Control and Prevention (US)
  • Rutgers, The State University of New Jersey (US)
  • Society for Applied Studies (IN)
  • University of Aberdeen (GB)
  • Miami University (US)
  • London School of Hygiene & Tropical Medicine (GB)
  • Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Northwestern University (US)
  • Stanford University (US)
  • Bond University (AU)
  • MRC Clinical Trials Unit at UCL (GB)
  • University College London (GB)
  • University of Exeter (GB)
  • University of Edinburgh (GB)
  • Harvard University (US)
  • Hospital for Sick Children (CA)
  • MaRS (CA)
  • Duke Medical Center (US)
  • University of California, Los Angeles (US)
  • South African Medical Research Council (ZA)
  • University of Warwick (GB)
  • MRC/CSO Social and Public Health Sciences Unit (GB)
  • St. Joseph’s Healthcare Hamilton (CA)
  • University of York (GB)
  • University of Alberta (CA)
  • University of Southern Denmark (DK)
Corresponding author
Chan, An-Wen
Venue
BMJ
Publisher
BMJ
Published
2025-04-28
Volume
389
Pages
e081477
ISSN
1756-1833 (ISSN-L)
OpenAlex
W4409878505
Cited by
460
References
50
Citations by year
2026: 358 · 2025: 102
FWCI
294.22
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
  • University of Birmingham Research Portal (University of Birmingham) (acceptedVersion, cc-by)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Bond University Research Portal (Bond University) (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research
  • Department of Health and Social Care
  • Medical Research Council (MR/W020483/1)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Keywords
trial protocol reporting, randomised trials, patient and public involvement, open science, trial design and conduct, reporting guidelines, CONSORT, TIDieR, Delphi consensus
MeSH terms
Clinical Trial Protocols as Topic, Delphi Technique, Humans, Research Design, Randomized Controlled Trials as Topic, Consensus, Checklist

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