Table 2.

Critical Appraisal Process to Assess Clinical Trial Generalizability

Guiding questions/steps	Appraisal considerations
Are the trial participants like my patients?	•Careful scrutiny of the eligibility criteria and descriptions of participants should occur including participants’ demographic details (e.g., gender, racial/ethnic diversity, social support, economic status, geography), clinical factors (e.g., diagnosis and disease stage and severity, comorbidities, performance status, timing of palliative care referral and of death), and caregiver factors (e.g., relationship, availability, and health status).22
	•Reviewing the trial’s CONSORT diagram will provide reasons for nonparticipation and for trial withdrawal, potentially highlighting systemic issues with implications for practice.35
Is the trial setting like my clinical setting?	•As the service structure, funding models, and policies of palliative care differ markedly, understanding the trial setting is essential.22 For example, if recruitment is drawn from a palliative care service, then referral policy will influence the study population.22
Are the intervention and its outcomes clearly defined and relevant?	•A clear, comprehensive description of the intervention is essential for it to be delivered as detailed into clinical practice. Furthermore, the benefits sought must be clinically significant (not the same as statistically significant) for patients.35
Be curious.	•The clinician appraiser should reflect on their own biases. Clinicians may have strong convictions about treatments, which may influence how they consider the evidence. Take a moment, reflect, and consider if this may be the case.

CONSORT, Consolidated Standards of Reporting Trials.