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The impact of palliative medicine?

© Arnold 1999 0267–6591(99)PM253ED The number of journals dedicated to health and social care expands each year, along with the number of articles published. But is the work being used, or even read? One indicator to assess this is the journal impact factor. This is a measure of the frequency with which others have cited the average article in the journal in a particular year. The underlying proposition is that if others are referencing the article it is considered important by peers – for research, for education or in influencing practice. Since 1961, impact factors have been used to rank scientific journals, although counting the number of times that an article was referenced to measure impact was proposed as early as 1927.1 The factor is calculated by dividing the total number of citations received by a journal in one year by the number of ‘items’ published in that journal in the previous two years. Other calculations can be based on the total number of citations for a journal, the speed at which citations appear, or their half-life. Palliative Medicine now has a sufficiently high impact factor to appear in the Journal Citation Reports league tables. Its impact factor of 1.86 is ranked 19/100 in the general medicine category and 14/100 in the public health category.2 This factor suggests that work reported in Palliative Medicine is being used by other doctors, nurses, social workers and researchers, not just within specialist palliative care, but also more widely. Many of those working in the field will see the achievement of this factor, within such a short history, as a sign that palliative care is influencing other disciplines to improve the care of patients and families. Other journals relevant to palliative care have similar impact factors. The Journal of Pain and Symptom Management has a factor of 1.92 and is one ranking higher (18/100) in general medicine. Supportive Care Cancer has a factor of 1.02 and the Journal of Palliative Care, 0.58. Examination of how quickly articles are cited and how long articles continue to be cited after publication show similar comparisons. These impact factors compare well with other specialist journals, such as the British Journal of General Practice at 2.01, Medical Care at 2.17 or the Journal of the Royal Society of Medicine at 0.66. But all are well below those of the British Medical Journal at 4.99 (ranked sixth) or the top two journals within medicine, the Lancet at 16.14 and the New England Journal of Medicine at 27.77. Impact factors are of growing significance. They are used to rank and evaluate journals and to assist in appraisal. They feature in the Research Assessment Exercise in the UK, in which the research activity of university departments is graded. Impact factors are also used as surrogates for publication quality. In order to be promoted, candidates in the USA and much of Europe should be publishing in journals with impact factors greater than 2. Consequently, authors seeking widespread influence will gravitate to journals with high impact factors. They will be influenced by pressure from their universities, promotion boards and funding bodies to target their work towards such journals. They may also believe that this will enable their work to be more accessible and more likely to affect care. Those who support the use of impact factors to evaluate journals argue that they are a quick, quantitative and transparent method. Because it takes several years for an average article to be cited, a journal’s impact may be used as a substitute for the evaluation of recently published articles. There is some evidence that doctors and nurses read high impact factor journals more often than other journals. Tsay found a significant correlation between library journal use, impact factor and how frequently articles were subsequently cited for both clinical medicine and life science journals.3 Impact factors also correlate with journal circulation.4 Editorial