CMAJ’s Statement of Purpose for Patient Engagement

In 2020, CMAJ committed to ensuring that patients (i.e., people with personal experience of a health issue, including families, and/or informal caregivers) are integrated within the journal's governance and operations and submit content to the journal. We have appointed a Lead of Patient Involvement.

This Statement of Purpose provides a roadmap for how we plan to embed patient and family perspectives in CMAJ.

Definitions

The following definitions have been adapted from the Canadian Institutes for Health Research’s Strategy for Patient-Oriented Research (CIHR SPOR).

Patient: Individuals with personal experience of a health issue as well as their family, informal caregivers and friends.

Patient partner: Patients involved in CMAJ’s governance, priority setting, conduct, editorial or review processes, and those who serve on staff as editors and/or in other roles within CMAJ.

Patient engagement: Meaningful and active collaboration with patients in governance; priority setting; conduct; editorial or review processes; CMAJ staff roles; and activities related to content creation, such as authorship, podcast interviews, and other knowledge generation and translation.

Why Engage Patients at CMAJ?

When talking about “knowledge that matters,” it is important to consider who decides what matters. As users of health care, patients are key stakeholders of the knowledge gained from research. They also fund health care (through taxes and privately) and have an interest in optimally functioning health care systems. Involving patients at CMAJ is important to:

• Respect, value and integrate expertise — Patients have expertise living with health condition(s) and navigating the health care system that health care professionals and researchers may not. As such, patients may provide different perspectives on what is important in terms of priorities, outcomes and ways to improve the system.
• Ensure justice, fairness and equity — Engaging patients is an issue of justice. Patient engagement promotes equity by giving attention to voices traditionally not included in discussions about health care and upholds fairness by allowing those who receive and pay for health care to be active in the decision-making process. Involving patients within the structure of the journal and as authors and reviewers means that patients become active partners in content creation and dissemination.
• Produce relevant and helpful content — Patient engagement can increase the likelihood that knowledge intended to benefit patients reaches them and is more likely to be helpful, accessible, relevant and appropriate for their needs. It can also provide physicians with a different lens through which to consider their clinical practice and how to communicate with their patients when providing care.
• Improve clinical practice — Hearing from patients how their conditions and the care they receive fit into their lives can help practitioners consider these aspects when delivering care.

We believe patients should have a voice in deciding what knowledge matters to the health of Canadians. Developing and sharing knowledge among patients, health care providers, researchers, managers and policy makers helps all parties understand the complexity and personal impact of health conditions and decisions. Involving patients is vital to CMAJ achieving the goal of identifying the best evidence, promoting the best clinical practices, and helping Canadians achieve their best health.

How Will We Engage Patients at CMAJ?

Our patient engagement program will be developed and expanded with time. We plan to involve patients within the journal in several ways and we will continually evaluate and change our engagement strategies based on feedback and evaluation.

In June 2020, CMAJ hired a lead of patient involvement to oversee the development of the patient engagement strategy and coordinate future patient-partnered initiatives within the journal. The lead of patient involvement will work with patient partners, patients and other CMAJ staff to establish ethical partnerships built on trust, with emphasis given to the principles identified in the Canadian Institutes of Health Research Ethics Guidance for Developing Partnerships with Patients and Researchers: mutual respect, equitable participation and rights, reciprocity and shared commitment to achieving meaningful health results, and personal integrity. Achieving true, productive partnerships built on trust will require time, training and ongoing support of both patient partners and CMAJ staff. We will develop a training and onboarding procedure for new patient partners and patient-partnered teams so that everyone has the information required to work together.

Although patient engagement will be encouraged and prioritized within the journal, patient involvement is not mandatory for all submissions.

We will use a range of strategies to integrate patient perspectives at all levels of the journal. For example:

• Direct partnership with patient partners
   
  1. Editorial Advisory Board — We will strive to have patients as members of CMAJ’s Editorial Advisory Board. The lead of patient involvement will work with them to develop and implement CMAJ’s strategy for patient engagement.
  2. Patient Core Group — Active from 2020-2021, this group worked with us to develop the strategy and resources we would need to roll out patient engagement across the journal.
  3. Patient Advisory Panel — In 2022, we created a Patient Advisory Panel of people from across Canada. This group identifies priority areas within the journal to tackle and co-creates new initiatives or solutions with journal staff.
  4. Patient Authors — CMAJ encourages pieces authored or co-authored by patients in all journal sections. We are in the process of revising our submission process to make it easier for patients who wish to contribute. Future options to increase the number of articles written by patients that are submitted to and published in CMAJ include author schools or bootcamps, patient coaches and matching of patients with researchers or clinicians.
  5. Communication and Dissemination of Publications — We will work with our patient partners to develop strategies to share CMAJ publications with wider audiences. This could take many forms, including podcasts with patient participants, videos, lay summaries or special features.
  6. Patient Peer Review — We will establish a group of patients interested in providing peer reviews for articles submitted to CMAJ and provide training to support them.
      
• Indirect support and integration of patient priorities
   
  1. Encourage Patient Authorship — CMAJ will amend its submission process to make it easier for patient authors. These changes will also make it easier for authors to indicate the contributions of patients on their teams or projects. Co-authorship among patients, health care professionals and researchers is encouraged, providing all meet the International Committee of Medical Journal Editors criteria for authorship.
  2. Highlighting the Use of Patient Partnership Methods — We plan to identify ways for authors to clearly indicate whether their research questions, methods, or outcomes were based on previous patient partnerships (e.g., prioritization exercises). Additionally, articles involving patients will be required to complete the GRIPP2 questionnaire to indicate how patients were involved in their work.
  3. Creating New Article Types — To date, CMAJ has created two new types of articles that require patient involvement in order for publication. These are “In Their Own Words” and “360 Cases.s” Both were created in an attempt to include patient perspectives in the Practice section of the journal, which provides ongoing clinical education for physicians.
  4. Prioritized Themes — We envision our patient partners identifying key themes that they would like to see highlighted within the journal. Articles addressing these themes may be commissioned or identified as areas of focus at CMAJ, with the ultimate publication decision still being made by the editor-in-chief and senior editorial team.
  5. Plain Language Summaries — In the future, research articles, analyses and commentaries may be required to include plain language summaries aimed at the general public to increase accessibility of their key findings.
      
• Evaluation of CMAJ's patient engagement program
   
  1. “Patients Included” Status — CMAJ content is freely available online, and the journal will seek to attain and maintain the remaining requirements to achieve “Patients Included” status (i.e., patients as members of the editorial board, peer reviewers, and authors).
  2. Measure and Report on Patient Engagement Activities — CMAJ will monitor and report on its patient engagement activities and initiatives to track their effectiveness.
      

Who Will CMAJ Engage as Patient Partners?

CMAJ is committed to including the voices of those who have traditionally been marginalized in society and in health care. We know that some groups of people in Canada still have trouble accessing the care they need, are suffering discrimination and have worse outcomes than others. It is important that our patient engagement activities reflect the breadth of the health care experiences and perspectives of people across Canada. CMAJ will strive for diversity at all levels of patient engagement in the journal, with particular attention to gender identity, ethnicity, socioeconomic status, age and geographical location (including rural/urban residence). We will strive to include the voices of people who are Black, Indigenous, and people of colour (BIPOC).