Should Your Journal be Involving Patient and Public Reviewers?

By Emma Doble
Patient and Public Strategy Editor, The BMJ
LinkedIn: https://www.linkedin.com/in/emma-doble-b0507783/
Bluesky: https://bsky.app/profile/emmajdoble.bsky.social

Take Home Points:

The role of patients and the public in peer review

The peer review process has been a cornerstone of healthcare research and publication as a standard practice since the 1970s. The process is widely accepted, despite many flaws, and aims to ensure research accuracy and quality before publication. Traditionally, the process involves experts in the field to review and provide constructive criticism to improve the quality of research and ensure the credibility and accuracy of the research published.

The value of involving patients, carers, and the public across healthcare is increasingly being recognized. People with lived experience of healthcare bring their own unique insights and experiences, which can help ensure healthcare research, design, and implementation are relevant and effective. The involvement, or co-production, of research with patients, carers, and the public has become more recognized in the last 10 years, but progress is slow. A 2025 meta-epidemiological evaluation found that only 64 of 360 (18%) randomised control trials over a 10-year period had reported patient and public involvement.

Despite patients, carers, and the public having much more of a voice in healthcare, they also often remain shut out of medical journals. One journal where the door has been opened for patients and the public to contribute to is The BMJ. In 2014, The BMJ launched its patient and public partnership strategy with a bold commitment to work with patients and members of the public across its processes and content. One of the early orders of business by the journal was to embed patients and the public into its review process. Patient and public review at The BMJ was launched soon after and focused primarily on randomized controlled trial research papers. Today, around 80% of research papers that are sent out for peer review in The BMJ are also reviewed by someone with lived experience. Patient and public review is now also conducted across all content types, including education and analysis articles.

How Does Patient and Public Review Work?

Since launching Patient and Public (P&P) review, there have been over 1,200 people with lived experience of healthcare who have signed up to review for us. Prospective P&P reviewers can sign up on our website, where they are asked to describe their lived experience of healthcare as either a patient, carer, or member of the public. We share our calls for P&P reviewers to sign up on social media, at conferences, and through our patient advisory panel and networks.

Once individuals have registered as P&P reviewers, they are added to our article processing system, where information on traditional peer reviewers is also held. This means when a paper is sent out for traditional peer review, editors will also ensure it goes to at least one of our P&P reviewers. It was important that these invitations all went out at the same time, as we wanted to ensure that patient and public review would not hold up the peer review process. The full process can be found in the infographic below.

Image used with permission. https://www.bmj.com/sites/default/files/attachments/resources/2017/10/bmjreviewprocess.JPG 

When papers are reviewed by a patient or member of the public, we ask them to focus on these key questions:

• Are the questions the paper addresses relevant and important to patients and/or carers?
• Are there topics or issues that are missing, or need to be highlighted more?
• Is the treatment or intervention suggested, or guidance given something which patients/carers can readily take up? or does it present challenges?
• Are the outcomes described/measured in the study important to patients/carers? Are there others that should have been considered?
• Do you have any suggestions that might help the author(s) strengthen their paper and make it more useful for doctors to share and discuss with patients/ carers?
• Do you think the level of patient/carer involvement in the study could have been improved? If there were none, do you have ideas on how they might have done so?

P&P reviewers are not required to have any scientific knowledge or to complete any training. Their role is to focus on the relevance and importance of the papers to them, or their community, while the traditional reviewers focus on the scientific rigor. Bringing these reviews and a variety of focuses and perspectives ensures the most holistic review of a paper.

Comments from the patient and public reviewers are considered alongside the comments from peer reviewers. They are used as a guide for editors reviewing the paper who make the final decision on whether the paper will be accepted or not. It is the editor’s responsibility to consider all the comments from reviewers to come to a decision alongside colleagues as well. We often have a patient editor involved in these decisions as well.

Challenges

There are many challenges in breaking down the wall between patients and journals. Inviting patients to review, alongside traditional reviewers, requires resources. Current submission systems may not be friendly for the general user, and so additional support and guidance may need to be provided. Patients and the public may also have additional questions about what to include in their review, such as what is in it for them, or they want to understand the review process, as it will be completely new to many of them.

If possible, having a named contact at the journal can often help patient and public reviewers feel they have support, but also that their work is appreciated. Having some specific training or supporting questions for patient and public reviewers can also help alleviate some of these concerns.

What needs to happen next?

The BMJ fundamentally believes that patients and the public should have a voice in healthcare. Without this input, many important and valuable insights may be lost, making the research or content not applicable or implementable beyond a publication in a journal. We continue to seek feedback from our P&P reviewers on the process and are always looking to find new ways to ensure they feel their inputs are acknowledged and appreciated. Evaluating the impact of P&P review is particularly challenging and something we are also keen to be able to demonstrate.

Most medical journals have the potential to benefit from involving and hearing from patient and public reviewers to ensure the relevance of the content they are publishing. In many cases, those already doing patient and public review started small by finding a subset of papers to test out their P&P review process while also establishing a database of P&P reviewers.

Considerations for other journals

For any journals interested in starting a P&P review, there are several lessons we have learned that may help. Starting small can really help get everything set up, e.g., focusing on a subsection of article types, health conditions, or articles that are most relevant to patient care or experience. It can also help to find an engaged patient community to work with through the first articles while you set up the processes. Being open to feedback from the P&P reviewers, authors of the papers, and editors can also give you great insights into how to make the process as seamless as possible within the current systems.

Conclusions

Patient and public reviewers can unlock a vast amount of useful insights when considering the relevance and application of research. It is important to integrate P&P review into the traditional peer review processes. Gathering and implementing feedback from P&P reviewers on the process is key to ensuring a successful implementation. Although getting started with P&P review can seem daunting, we hope we are demonstrating how it can be done and that the outcomes are gaining a more holistic review of the research for consideration.