Abstract
The person who most bears the brunt of the work preparing each issue of JPM is Lisa Pelzek-Braun, our capable Managing Editor, who has been with JPM since its inception 13 years ago. Lisa's responsibility has grown from putting an issue together 4 times each year, to monthly. For all of us, the move to monthly publication feels like increasing the pace in a long run as part of a training regime: we are all a bit breathless. Happily, our publisher allows the journal to grow as the field has grown.
In the spring of 2009, editors from the leading journals serving our field presented their philosophies in a session at the European Association for Palliative Care annual meeting in Vienna. A similar session is planned for the annual assembly of the American Academy of Hospice and Palliative Medicine in March 2010 in Boston. Despite similarities in form (all good scientific journals send submitted articles for peer review, try to select the best, and submit their issues to the publisher by the deadline), there is no doubt that each editor gets to influence the shape of his or her journal. Many have urged me to make my guiding philosophy for JPM explicit. Fortunately, after 5 years in this role, I have one!
The Journal of Palliative Medicine serves three audiences. The first is the subscriber. Those subscribing to Journal of Palliative Medicine are overwhelmingly clinicians. The subscriber is often working alone or in small groups and wants to learn the latest developments in the field. The subscriber also wants to feel part of a larger community that extends beyond those she or he works with on a daily basis. Journal of Palliative Medicine serves to connect subscribers to “our tribe” around the world. Subscribers are largely silent; we know them by their subscriptions. The second is the author. The number of researchers in hospice and palliative care is far smaller than the number of clinicians. Authors want to see their work published, promptly, in high impact journals for the purposes of advancing the field, as well as advancing their own careers in their academic medical centers. Authors are vocal; it would be easy to mistake them as the primary audience of the journal. The third group is those who search (usually electronically) for a article on a particular subject. To them, it does not matter in which journal the article is published; they are interested in a topic, and want to read concisely written reports that help them answer questions.
The Journal of Palliative Medicine must include all levels of evidence that influence clinical practice. The highest level evidence (meaning, likely to be the most accurate) is the prospective randomized clinical trial. The lowest level of evidence (meaning, it is most likely to be inaccurate) is personal experience with single or small series of patients. There are many levels in between. Interestingly, when trying to solve a clinical problem, the most useful information is often from the lowest level of evidence. That is why we all rely so heavily on each other for advice. “Have you seen a case like this; how would you handle this?” This is because, by their very nature, randomized controlled trials rarely include patients precisely like the one before us, or cannot be designed ethically to answer the most important questions.
I have structured Journal of Palliative Medicine with a stair-step approach meant to mirror the stair-steps of levels of evidence, and the stair-steps that each of us tread on our way to becoming better clinicians and students of the field. The research report (3000 words) is reserved for those manuscripts that report the best designed, most scholarly, and most valid information the field has to offer.2–5 For research that is at an earlier stage, where the number of subjects is small or where the hypotheses are still being worked out, JPM offers the Brief Research Report (1500 words).6–8 This is where more junior authors will first appear. Then, for those with a good idea or some interesting observations resulting from a case or two, there are the research letters (500 words). 9 For many, a letter may be the first time the author appears in print. In my experience, the work described in a letter is often the most innovative and inspiring for future research directions. Then, the rest of the journal must feed the subscriber's other needs. Case reports link the existing evidence base in a clinically applicable way to an interesting case. Personal reflections give voice to the challenges of working in the field, or of studying the field. Editorials, Special Reports, Fast Facts, News and Views help readers make sense of the work that is published and the political and social forces that influence our work. I am so pleased that V.J. Periyakoil has begun to develop and edit a comprehensive series of clinical reviews. 10 Finally, while not under my editorial control, Briefings are prepared by our publisher and sent weekly by e-mail to all subscribers as a way to provide relevant information that cannot be accommodated in a print journal that takes 3 months to typeset and mail.
In summary, the Journal of Palliative Medicine aims to be the journal of record that includes everything a clinician needs to improve our abilities to prevent and relieve suffering and improve quality of life at every stage of life for those with serious illness. In 2009, Thomson Scientific calculated our first Impact Factor for JPM at 1.909. That is extraordinarily high; it means that even though we aim to meet the needs of clinicians, every article is cited in the scientific literature an average of 1.9 times in the 2 years following publication. The vast majority of scientific journals have an impact factor of less than 1. In other words, we are having an impact. I think I will keep my editorial philosophy as we enter a period that I think will be a golden age for hospice and palliative care.