Objective Despite increased integration of patient, family, and caregiver (henceforth referred to as “patient”) perspectives in health care and research, limited information exists regarding patient inclusion in academic publications,1 and medical editors remain divided about the appropriateness of patient authorship.2 Understanding the level of patient involvement can establish a baseline with which to assess the success of future efforts. This work examined the type and frequency of patient involvement in works published by a general medical journal prior to its adoption of a patient engagement policy.

Design In this cross-sectional study, articles (editorial, research, guideline, clinical review, commentary, humanities, analysis, and practice), podcasts, and blog posts published by the CMAJ between 2018 and 2020 were analyzed to assess how frequently patients were involved as authors, article contributors (eg, as members of advisory panels or patient- partnered teams), podcast interviewees, or subjects of patient profiles.

Results Overall, 97 of 973 articles (10.0%), 18 of 175 podcasts (10.3%), and 28 of 323 blog posts (8.7%) reflected patient involvement. The journal had published a special supplement focused on patient involvement in 2018 and launched a “Patient Portrait” series in 2020; these were the only instances in which the CMAJ editorial team explicitly solicited work involving patients. When articles published in special supplements were excluded, 6.6% of articles (62/933) involved patients. The highest rate of patient involvement was seen in guidelines (85% 17/20), followed by commentaries (21.4% 37/173 when including articles published in special supplements and 1.5% 2/136 without), humanities (17.4% 34/195) (which included “Patient Portraits”), analysis (6.3% 3/48), research (2.4% 4/167), and practice (0.6% 2/312) articles. No editorials or clinical reviews involved patients in the period under study. Patient authorship was the most frequent type of involvement (46/97 47.4% overall; 25/34 73.5% humanities, 16/37 43.2% commentaries, 4/17 23.5% guidelines, and 1/2 50.0% practice articles). Other modes of patient involvement included patient-partnered teams (39/97 40.2%) or advisory groups (35/97 36.1%), incorporating patient preferences in methods (24/97 24.7%), patient profiles (8/97 8.2%), and mentioning patient contributions in the acknowledgment section (7/97 7.2%). Most patient authors of humanities articles were people who had worked in health care or research.

Conclusions At CMAJ, 10% of all published products (97/973) from 2018 to 2020 reflected patient (including family and caregiver) involvement. Overall, 6.6% (62/933) occurred without the journal explicitly soliciting content including patients. A large proportion of the articles that listed patient authors were published in special supplements or written by people who had worked in health care. These data will serve as a baseline as CMAJ seeks to increase patient involvement across the journal.

References 1. Price A, Schroter S, Snow R, et al. Frequency of reporting on patient and public involvement (PPI) in research studies published in a general medical journal: a descriptive study. BMJ Open. 2018;8:e020452. doi:10.1136/ bmjopen-2017-020452

2. Cobey KD, Monfaredi Z, Poole E, Proulx L, Fergusson D, Moher D. Editors-in-chief perceptions of patients as (co) authors on publications and the acceptability of ICMJE authorship criteria: a cross-sectional survey. Res Involv Engagem. 2021;7(1):39. doi:10.1186/s40900-021-00290-1

Conflict of Interest Disclosures All authors are employed by the CMAJ.