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Funding agencies, research ethics committees/institutional review boards, regulatory agencies, medical journals, systematic reviewers, and other groups rely on protocols to appraise the conduct and reporting of clinical trials.

To meet the needs of these diverse stakeholders, protocols should adequately address key trial elements.

For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance.

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The SPIRIT recommendations are intended as a guide for those preparing the full protocol for a clinical trial.

A clinical trial is a prospective study in which one or more interventions are assigned to human participants in order to assess the effects on health related outcomes.

This E&E paper provides important information to facilitate full understanding of each checklist item, and is intended to be used in conjunction with the SPIRIT 2013 Statement.14 These complementary tools serve to inform trial investigators about important issues to consider in the protocol as they relate to trial design, conduct, reporting, and organisation.

To identify examples for each checklist item, we obtained protocols from public websites, journals, trial investigators, and industry sponsors.

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