A square peg in a round hole: Patient and public author affiliations in academic journals

As more research teams include patient and public authors in their work, the topic of affiliation for these authors is coming to light. The academic publishing model is one which assumes that most, if not all, authors have an academic, health services or industry-based affiliation, however patient and public authors do not necessarily fit this mold. Given that research is bringing to light journal Editors-in Chief beliefs related to patient partner authorship¹, work that identifies how patient partners may meet International Committee of Medical and Journal Editors’ criteria for authorship in patient engagement and patient-oriented research projects², and most recently, a study on identifying scientific articles that include patient partner authors³, we feel this is a timely discussion. Here we share our thoughts on this evolving situation, provide solutions for teams that include these types of authors, and issue a call to action for journal editors.

Patients and public authors, should they wish to be publicly cited as such in publications, should have an opportunity to choose their preferred type of affiliation. Currently it appears that many patient and public authors are affiliated with a patient organisation to which they belong or the organisation that carried out the research highlighted by the publication. While this may work for some patient and public authors, we argue that this is not the case for all patient and public authors, some of whom may wish to not have an institutional affiliation or who don’t have an institutional affiliation. In fact, for some patient and public authors, needing to affiliate with the institution that is leading the research may not be appropriate. While these individuals may have received some form of compensation for their contribution to the project highlighted in the publication, they are rarely under employment contract to these institutions and certainly rarely act or speak on behalf of the institution. To call these authors affiliated with these institutions may not be the correct interpretation of the relationship. Most patient partners bring an independent perspective to the research they get involved with and may feel that could be compromised by being affiliated to the institution. Being a co-author is a form of reward and recognition for the contribution patient and public authors have made to the research.

We propose that these patient and public authors should be able to choose their own affiliations and it is the responsibility of the lead author to offer that.  We have recently seen some patient and public authors choose to list their affiliation as ‘patient partner’ or ‘patient research partner’ ^4,5, or as the location where they live.⁶ We further suggest that terms such as ‘public partner’ ⁷ ‘independent patient or public partner,’ and others may be useful affiliations. In the event that patient and public authors do have affiliations that make sense for their situations, we also feel that appropriately highlighting that patient and public members have contributed to the work of the publication is important.³

We are bringing this issue to light because we feel strongly about contributing to the science and knowledge related to patient and public engagement and involvement. This is an emerging field, and it is important to realize that current processes and systems do not easily accommodate patient and public involvement. As the field of patient and public involvement in research, healthcare, and health policy continues to evolve, so does the importance of being able to understand how and if patient and public partners have contributed to this work, in what ways, and how. Current tools such as the GRIPP⁸ and GRIPP2⁹ reporting tools are helpful, as are simple approaches such as detailing who patient and public partners are within the contributions section of publications. Whilst that is clearly important, the contributions section is usually placed at the end of most papers and may be missed by some readers. We feel that it is important that the contribution of patient and public authors is made more visible through an appropriate affiliation on the first page. Moving towards this as a choice for all patient and public contributors to research will start to reveal the full extent and impact of the contributions they make, which has hitherto been far from clear in journal papers.¹⁰ The lack of a clear way to indicate that one or more co-authors is a patient and public author leads to an underreporting of the numbers of patient and public partners who have contributed to the writing of published papers. It might also give the impression that patient and public authors lack the skills to do this or that they are not interested, neither of which is true in our experience.

With this context, we issue a call to action to journal editors to develop an approach to help ensure that patient and public authors who want to be recognised as such can use an affiliation of their choice. At its most basic form, journal submission software should offer flexibility to allow for this type of ‘affiliation.’ A more advanced exercise would be to develop guidance for lead authors in collaboration with patient and public contributors who have been co-authors of published papers.  Specific approaches might need to be developed for academic, commercial and health services organisations that offer some options for appropriate affiliations.