Dawn Lobban, PhD, Envision Pharma Group, Wilmslow, UK; Jacqui Oliver, PhD, Envision Pharma Group, Wilmslow, UK; Alexandra Freeman, DPhil, University of Cambridge, UK; Simon Stones, BSc (Hons), Envision Pharma Group, Wilmslow, UK; Abbie Pound, BSc/BA, Ipsen, Slough, UK
Since the global pandemic started, there has been immense pressure to address the threat imposed by COVID-19. Researchers have risen to the challenge and, by working collaboratively, developed effective vaccines and identified some treatment options over an impressively short timescale. Despite the success of key clinical trials investigating treatment options (e.g., the preeminent COVID RECOVERY trial), vaccine development and rollout, multiple challenges have emerged in the handling of the communication of evidence and research. Many of these challenges arise from cracks in the scientific communication system, which have been evident for some time but have been overlooked or papered over. These fissures have been magnified by the pandemic and now need to be tackled to ensure that information is communicated through the right channels, in the right way, at the right time, and often simultaneously to all relevant audiences.
|The World Health Organization (WHO), in a joint statement with other global health organizations, called on stakeholders to ensure that they are “promoting the timely dissemination of accurate information, based on science and evidence, to all communities, and in particular high-risk groups; and preventing the spread, and combating, mis- and disinformation while respecting freedom of expression.”|
Managing the Volume of Data (the Infodemic)
Research into COVID-19 has resulted in a deluge of disparate and uncoordinated information from around the world distributed through multiple channels, including via congresses, preprint servers, press releases, journals, and agencies that provide official national statistics. While the challenge of volume of information is particularly acute in a pandemic situation, the amount of research and information across all disease types, irrespective of urgency, is increasing. The amount of information can be overwhelming for those who engage with it—whether they are patients, carers, healthcare professionals, researchers, or journalists. Yet, there are alternative ways to communicate research beyond the traditional peer-reviewed manuscript, several of which offer advantages over traditional journal publications for many audiences. Unfortunately, both academic and industry publication team success is often measured by the number of manuscript publications, adding to the deluge.
We need to challenge the metric of measuring success by number of publications; instead, we should move towards using metrics that relate to the quality of the publication and its aims, whether that be changes in behaviour or policy, or increases in reach, understanding, and decision satisfaction in different audiences. Furthermore, the traditional approach of publishing an article (or several) for each piece of research may not always be the most effective way of communicating data, and collaborative databases or constantly evolving reviews of the evidence could offer more effective, informative, and manageable approaches. This could encourage rapid coalescence of data collection and reporting, which aids synthesis.
Innovative use of collaborative and evolving datasets
|Living systematic reviews||Provide an approach to publishing evidence that is trustworthy and up‑to-date, enabling collaborations between research groups and adding relevant evidence as it becomes available, e.g., Cochrane living systematic reviews.|
|Online datasets||Platforms, such as ourworldindata.org, show how it is possible to publish rapidly changing information without adding to the volume. This approach allows people to filter the information that is most relevant to them.|
Communicating to Multiple Audiences through Different Channels
The pandemic has emphasized the need for the public, policy makers, and journalists, in addition to researchers and healthcare professionals, to have access to the latest scientific information via mainstream channels, with indicators as to what the data might mean to them. Important evidence is often published but then locked behind paywalls or hidden in scientific/technical jargon or in statistical terms, which are difficult to translate into meaningful and relatable terms, in niche academic papers. We’ve seen journals make COVID-19 papers open access—but why should this only relate to COVID-19? Do other patients and the public not deserve the same level of access to relevant research in fields relating to them? Open access journals are vital in the drive for collaborative problem-solving in science, as well as in the dissemination of information to those who need it to make decisions.
Clear communications for nonspecialists and for those wanting to use the findings in clinical or policy-making situations, such as plain language summaries (PLS), should be encouraged for all publications.
Making evidence accessible to all
|Plain language||Using language that is easily understood (lack of jargon, clarity of terms) helps multiple audiences, including patients, journalists, healthcare professionals, and policy makers, who may not be experts in a specific scientific field.|
|Translate statistics into key numbers||Translating statistical findings into the key numbers needed by someone who wants to understand the implications for individuals or populations (as appropriate) is vital to avoid misinterpretation and help identify clinical rather than statistical significance.|
|Well-designed visuals||Visuals (both quantitative figures and iconography) can aid understanding and are more readily shared, e.g., via social media channels, extending the reach to broader lay audiences.|
Working with proactive publishers can extend the reach of research findings through the use of enhanced content (e.g., PLS, video abstracts, interactive data tables). Moving away from publication plans to data dissemination plans that consider multiple formats and channels can extend the reach of research to wider audiences. Providing translations of PLS may help overcome language barriers, and patient associations/societies can further extend the reach by (re)publishing PLS on their websites. Delivery is just as important as the quality of the information, and co-operating with key stakeholders can help to ensure that information objectively reaches all audiences in their familiar environments.
Communicating Rapidly Changing Data and Uncertainty
Owing to public interest, rapid discoveries, and widespread health implications of information relating to COVID-19, communicating data in real-time has been acutely important during the pandemic, creating a rapidly evolving body of evidence. How ‘accuracy’ of reporting research is ensured is usually down to the individual journalist and how much understanding they have. A Universal Ethical Code for Scientists encourages authors to take responsibility for their research and communicate results honestly and accurately to support communication between scientists and the public.
Communicators have faced an unenviable challenge of ensuring that COVID-19 information is timely, trusted, accurate, and in context in real-time, raising the profile of problems that have been building up for decades. The importance of accurately and rapidly communicating complex data has been demonstrated in recent discussions on putting risks into context: covid-19 vaccines and blood clots.
Although the need to improve public health literacy is recognized, trust in information sources is at a record low. We need to ensure there is easy access to, and improved understanding of, trustworthy scientific data. Data should be communicated with all relevant uncertainties and caveats, to ensure accurate interpretation by various stakeholders. While the value of peer review in ensuring scientific integrity has long been recognized, the need for rapid publication during the COVID-19 pandemic has highlighted the limitations of the traditional publisher‑driven peer-review process, which can cause significant delays and sometimes unwarranted trust in peer-reviewed findings. Peer-review comments can be subjective and highly variable, depending on the reviewers’ own epistemological positions. Indeed, post-publication critiques and scrutiny during the pandemic have brought to light simple mistakes — and deeper failings — within studies that passed peer-review and might, under other circumstances, have been accepted into the primary research record.
An increased reliance on preprint servers and press releases for COVID-19 information has led to data being shared more rapidly and openly than is typical, but without the established peer-review step. All those reading preprints need to be made aware of their status — and the meaning and value of peer review — to enable them to critically assess information. Alternatively, post-publication peer-review could be integrated into the preprint system so that reviews by other readers can easily be read, aiding assessment of the research findings. To uphold data integrity and quality, publication professionals and journalists must ensure that the status, and likely quality, of data is clear and whether it is subject to future updates. Preliminary data that have not yet been peer-reviewed or even publicly shared in full should be labelled as such and should be removed and replaced with the peer-reviewed data once available to prevent confusion. As such, ISMPP, the American Medical Writers Association (AMWA), and the European Medical Writers Association (EMWA) have published a joint position statement on medical publications, preprints and peer review.
Given the extensive volume of research findings, communicators also have a key role to play in helping to prioritize data, provide context, and manage uncertainty, as summarized below.
|Communicating context is key to understanding relevance at both an individual and population level.|
|Confident communication of uncertainty, including the quality of the underlying evidence, can build trust in research findings and facilitate understanding of an evolving body of evidence, as well as supporting evidence-informed decision-making.|
|Effective communications can pre-empt misunderstandings and avoid inaccurate implications of causation when research is further shared through media stories.|
A rapidly changing evidence base presents challenges, not only for the public in terms of understanding, but also for healthcare professionals and those who develop healthcare/treatment guidelines. To accelerate evidence into practice, some publishers and related groups, like The BMJ and MAGIC Evidence Ecosystem Foundation, are using authorship and publication platforms to work with international groups of researchers, healthcare professionals, and patients to provide an assessment of the evidence, rapid recommendations, and living guidelines.
Key Considerations for Publication Professionals
|Prioritise quality||Agree on the aims of your publications. Then, use metrics that help to assess the quality of publications by success against their agreed aims, rather than simply quantity.|
|Consider context||Contributing to collaborative databases or constantly evolving evidence reviews may be a more effective and informative approach than individual publications for every dataset.|
|Consider the needs of multiple audiences||Data dissemination plans may help to extend the reach of research to wider audiences. Work with proactive publishers who offer enhanced content options (e.g., PLS, video abstracts, interactive data tables).|
|Ensure transparency||Make it clear when data have not yet been fully peer-reviewed (e.g., congress abstracts, preprints) and replace with peer‑reviewed data once available. Be upfront about limitations, uncertainties and the quality of the evidence.|
As medical publication professionals, we can play an important role in addressing communication challenges that have been exposed by the COVID-19 pandemic to ensure that scientific publications are timely, understandable, relevant, and inclusive across all therapy areas and audiences. Let’s take the challenges thrown at us by the pandemic and work together to resolve them for the future good of the industry and of the patients we all serve. To miss this opportunity to learn and evolve would be both short-sighted and, indeed, unethical.
The views and opinions expressed in this article are those of the authors, based on their expertise, and do not necessarily reflect the views or positions of their employers.