New requirements for patient and public involvement statements in BMJ Open

Patient partnership at The BMJ: Walking the talk

In 2014, The BMJ launched it’s patient partnership strategy, seeking “to promote patient partnership by walking the talk“. The strategy, informed by an international patient advisory panel, launched a number of innovative editorial practices, including patient peer review and patient co-production of educational articles.

Listening to patients’ voices (and making them available through open peer review) has proved enlightening. Patients bring new perspectives to established processes and demonstrate a strong desire for involvement. Patient participants are highly engaged and want their voices to be heard–and they want to be involved every step of the way.

In 2015, as part of the patient partnership strategy, The BMJ began requiring authors to include a Patient and Public Involvement (PPI) statement in all research articles. The INVOLVE group–the national advisory group for public involvement in research–defines PPI as research actively carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’, or ‘for’ them.

It is hoped that requiring the reporting will encourage the practice. Increasing the practice could have a myriad of extremely positive benefits including improved reporting, improved best practice, and a reduction in research waste.

Today we published an important article from Amy Price and colleagues analysing the PPI statements in The BMJ before and after the PPI reporting requirement. In the year before the PPI reporting requirement, 0.5% of research articles reported PPI activity. In the year following the requirement, 11% of research articles reported PPI activity.

While the new requirement was associated with an increase in reporting PPI involvement, the numbers are far below where they should be. The PPI statements also demonstrated substantial variation in quality and content. While some articles described innovative approaches to patient involvement, others demonstrated a lack of awareness of the very concept. More education is needed.

There is a lot of work to do, and we are far from where we want to be, but, according to Price et al., requiring a PPI statement is a simple step that journals can take to help integrate meaningful PPI into the research culture.

BMJ Open now requires a PPI statement for all submissions

The editorial team at BMJ Open have been inspired by the work of the patient involvement team at The BMJ. Following their lead, we are now requiring authors of all submissions to the journal to include a PPI statement.

The PPI statement should appear at the end of the Methods section. It should answer the following questions:

  • How was the development of the research question and outcome measures informed by patients’ priorities, experience, and preferences?
  • How did you involve patients in the design of this study?
  • Were patients involved in the recruitment to and conduct of the study?
  • How will the results be disseminated to study participants?
  • For randomised controlled trials, was the burden of the intervention assessed by patients themselves?
  • Patient advisers should also be thanked in the contributorship statement/acknowledgements.

If patients were not involved, authors must state this.

Including PPI statements aligns closely with BMJ Open‘s values of transparency and inclusiveness. We hope that including PPI statements in all articles is the first step of many for BMJ Open in encouraging patient involvement.


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