Narrative reviews are possibly one of the most challenging article types to write. Yet, on the ladder of evidence, they rank the lowest. Rightly so, because they are not based on actual studies like original articles, nor are they based on an analysis of all evidence related to a topic like systematic reviews or scoping reviews. If I were to describe a narrative review very simply, it is the authors’ narrative on a topic, based on the published literature that they choose to select. In that case, logic says narrative reviews should be the easiest to write, isn’t it? One could say yes, if the objective is to just get them published in some unknown journal, irrespective of whether anyone will ever read or cite the article. However, if the authors wish to be respected for their perspective, the objective should be to publish the article in leading journals. Here is where it gets very challenging. Many leading journals do not accept narrative review articles or accept them only by solicitation, much like expert opinion articles. This is because narrative reviews can be very biased because the author(s) choose supporting evidence at will. I had previously written about how to write expert opinion articles. The bigger challenge with narrative reviews is that the authors might not necessarily be KOLs; hence, they might not be invited to write a narrative review article. The only way to achieve a successful publication is by making it honest and interesting to read so that the journal editors are convinced that it will be useful to the readers and not create a bias.
The most important part is selection of the topic. Can the topic really provide useful insights to a clinician? This usually requires some thought about topics that the author(s) himself/herself would find interesting to read as a clinician, but about which not much is often written, or questions that clinicians would like to ask a KOL. Or maybe the authors have observed some unique patterns in clinical practice but found that there is not much literature around it and feel that sharing these with peers would be helpful. Once some probable topics have been listed, it is a good idea to look up published literature on the same topics to check whether recent and adequate literature is available and whether some unique perspectives that clinicians would be interested in reading about can be highlighted through the article. As an example, clinicians might not be interested in reading just another review article on a gliptin or insulin in controlling diabetes or a specific calcium channel blocker in controlling hypertension. However, a review article on their pleotropic effects, or specific patient profiles who might show superior benefits with these agents, or an article on some controversies about using or not using two specific drugs together (e.g., use of DAPT and specific PPIs) might attract more interest.
Before starting, the most important question to ask the client/author is what are the core messages they intend to convey through the manuscript. Once the discussion with the author(s) is done, here is how I proceed with writing the review article. I start by reading the latest evidence and literature on the topic especially the most recent practice guidelines to understand the subject matter. Sometimes no guidelines are available on the topic e.g., if a narrative review article on an antibiotic is to be written. In such cases, clinical trials and RWEs are the main evidence one has to rely on.
When writing the article, the flow should be very smooth with every sentence and section logically leading to the next one. A common mistake I see is writers using evidence almost 15 to 20 years old. In medical writing, the golden rule is to stick to the last 5 years’ literature and use older literature only when it becomes an absolute must due to nothing having been published on the topic recently. Another important aspect is objectivity. Evidence for as well as against each section should be presented before ending it with the author(s) perspective on why he/she/they think they think some evidence(s) is more convincing. This keeps the narrative balanced and not overtly biased and increases the chances of publication in a reputed journal.
There are no rules regarding the section headings for a review article, unlike that for an original article. The standard accepted length of narrative review articles is 2500 to 4500 words.
The most important step is publication. It is important to be clear about the target audience and choose the journal accordingly. For e.g., if your target audience is cardiologists in India, it might not help to achieve publication in a low-impact international journal. Of course, publication in a high-impact international journal should be attempted as that increases readership and citations. However, instead of a low-impact international journal, a local journal with a good readership is preferable. Your KOLs and the authors themselves could be helpful with suggesting journals as well. After creating a list of journals, it is important to read through their scope, author guidelines, turnaround time, some recent editions, etc, and rank them in order of priority. To save time, it is important to be practical and rank them objectively rather than trying to be overambitious, as this only delays the publication.
Despite the challenges, there is no reason why an honestly and well-written review article on a clinically useful topic should not get published. In fact, there is an international and reputed journal that focuses on review articles and has a high impact factor. Check out here https://www.nature.com/natrevmats/journal-information
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