Gary S Collins , 2025-04-14 22:00:00
- Gary S Collins
, professor of medical statistics
1Centre for Statistics in Medicine, UK EQUATOR Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- gary.collins{at}csm.ox.ac.uk (or @GSCollins on X and @gscollins.bsky.social on Bluesky)
“Readers should not have to infer what was probably done; they should be told explicitly.” Douglas G Altman 1
The 2024 update to the Declaration of Helsinki states: “Researchers have a duty to make publicly available the results of their research on human participants and are accountable for the timeliness, completeness, and accuracy of their reports. All parties should adhere to accepted guidelines for ethical reporting.”2 In an era where health research influences everything from clinical practice to public policy, ensuring the reliability and trustworthiness of scientific findings is critical. For clinicians, well reported studies provide the evidence they need to make informed decisions about patient care. For policy makers, they offer a reliable basis for shaping public health interventions. For patients, they ensure that the treatments they receive are grounded in robust and transparent science.
Yet weak study design, inappropriate methods, and incomplete reporting continue to plague health research.13 These limitations can undermine public trust and the wider credibility of science; waste resources; and, most critically, harm patients when flawed evidence informs clinical practice.4
Reporting guidelines are structured tools that take the form of a checklist of reminders. They have been designed to standardise how research is reported so that readers can understand why the research was carried out, how it was carried out (exposing poor design and weak methods), and what the findings were and their implications. Reporting guidelines also have a pivotal role in ensuring transparency, which is a core tenet of open and reproducible research.5
Reporting guidelines—such as the newly updated CONSORT 2025 statement and the forthcoming SPIRIT 2025 statement for clinical trials,6789 PRISMA 2020 for systematic reviews,10 and TRIPOD+AI for predictive artificial intelligence11—were developed to tackle the problem of incomplete reporting. The latest CONSORT 2025 iteration is its fourth since it was introduced almost two decades ago in 1996.12
Launched in 2008, the EQUATOR Network, an international initiative to promote accuracy and transparency in the health research literature, hosts a library currently listing over 600 reporting guidelines. However, despite the breadth of available guidance, and being firmly established as part of the research and publishing ecosystem, reporting remains suboptimal. Although studies have shown modest improvements over time,13 the problem of incomplete reporting still persists across various study designs, including randomised controlled trials,13 observational studies,14 systematic reviews,15 clinical prediction models,16 diagnostic test accuracy research,17 and animal research.18
Several perceived barriers hinder the uptake and implementation of reporting guidelines.19 Firstly, researchers often view reporting guidelines as burdensome, adding to the already heavy administrative load of conducting and publishing research. Secondly, journals and funders often fail to enforce or verify their use. Who checks the reporting or veracity of the authors’ completed checklist: it is not always clear who has this responsibility, and the lack of explicit oversight can create a culture where adherence is seen as optional rather than essential. Finally, researchers are not always aware of or trained on the importance of transparency and how to achieve it.20
Tackling the challenges of implementation
Future reporting guidelines need to tackle the challenges of their implementation head on and introduce appropriate incentives, starting with mandating adherence through policy. Journals, preprint servers, funders, and regulatory bodies must make adherence to reporting guidelines a non-negotiable requirement for the publication, funding, and approval of research. Since 2005, the International Committee of Medical Journal Editors has mandated that all clinical trials should be registered on a public registry before publication,21 providing a blueprint for how such interventions in scientific publishing can be achieved. Mandating adherence to reporting guidelines would similarly signal that transparent and complete reporting is not optional but a fundamental aspect of scientific integrity.
Since journals profit from publishing research often funded by public money and conducted with patient participation, they should be independently audited and monitored for completeness of reporting. For their part, journals should also put systems into place to make sure the appropriate guideline is adhered to. Such accountability will ensure they honour their ethical obligation to disseminate findings fully and accurately and fulfil their role as stewards of science, protecting both the integrity of the scholarly record and the public that depends on it.
More could be done to support authors in following checklists. Emerging technologies such as generative artificial intelligence and large language models could be used to develop tools for authors that reduce the burden of using a reporting guideline. Such technology could also be leveraged by journals to automate checks for adherence to guidelines, including crosschecking for consistency against any registry information and study protocols.22 The EQUATOR Network and reporting guideline development groups should also consolidate, streamline, and harmonise reporting guidelines to reduce fragmentation. A unified, user friendly framework (eg, an item bank of reporting items and examples of good reporting23) along with structured templates, which adapts to different study types while maintaining core principles of transparency, would make adherence more feasible for researchers.
Finally, universities, research institutes, and funders should invest more in education and training. Transparency and reporting guidelines should be integrated into research (integrity) training programmes.24 Workshops, online courses, and mentorship initiatives can equip researchers with the skills and knowledge needed to apply these tools effectively.
The future of health research depends on our ability to produce evidence that is not only innovative but also trustworthy. Reporting guidelines are pivotal to this endeavour. They not only improve research but also help to safeguard public health. By mandating their use, streamlining their implementation, and investing in education and technology, reporting guidelines can be transformed from optional aids or administrative hurdles to essential instruments of scientific integrity.
Patients, clinicians, and policy makers rely on research to make life and death decisions. We owe it to them to ensure that the evidence they depend on is as reliable and transparent as possible. Let us make reporting guidelines the standard, not the exception, and in doing so, ensure trust in the science that shapes our health and our future.
Footnotes
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Competing interests: GSC is a statistics editor for The BMJ, and director of the UK EQUATOR Centre.
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Provenance and peer review: Commissioned; not externally peer reviewed.