Lancet Workflow Router (lancet-workflow)

Overview

This is the router. It does not replace any specialized skill. It tells you which lancet- skill to use at the current stage* of a manuscript aimed at The Lancet.

Default assumption: unless the user states otherwise, the target is The Lancet (the flagship clinical/global-health weekly), not a Lancet family title (Lancet Global Health, Lancet Public Health, EClinicalMedicine, or a specialty journal such as Lancet Oncology). Family titles share house style but differ on scope and audience — flag the difference and route to lancet-fit if the user names one.

When to trigger

• "What should I do next with this clinical manuscript?"
• A draft arrives and you must diagnose the current bottleneck.
• The user is moving between trial conduct, writing, and revision and has lost the thread.
• Reviews arrive from The Lancet (including a statistical reviewer) and you need rebuttal mode.

The single most important gate

The Lancet rejects most submissions without external review. The editorial bar is not technical correctness alone — it is clinical or public-health importance, global relevance, and impact on practice or policy, often with an equity lens. So the first question is never "is the trial sound?" — it is "does this change practice or policy for a globally relevant problem?" Route to lancet-fit first, always.

How The Lancet differs from NEJM / JAMA / BMJ

• The Lancet — international and global-health-forward; an explicit advocacy voice; strong on health equity, public health, and policy; large multi-country trials; article types include Articles (original research), Seminars, Reviews, Comment, and Correspondence, plus the Lancet family of specialty journals.
• NEJM — clinically definitive, often US-centric, conservative house style; no Research-in-context panel.
• JAMA — clinical + health-policy, structured abstracts, strong methods/statistics editing.
• BMJ — open access, generalist, strong on EBM and patient partnership; "What this paper adds" box.

The Lancet's distinctive artifacts are the Research in context panel (with a systematic-search Evidence-before-this-study section), the Findings/Interpretation/Funding abstract headings, and the explicit role of the funding source statement.

Routing table

Default order

1. lancet-fit — clear the importance / global-relevance / policy bar first
2. lancet-study-design — registration, protocol + SAP, design rigor
3. lancet-reporting — EQUATOR guideline + flow diagram for the study type
4. lancet-statistics — pre-specified analysis, ITT, CIs, subgroups
5. lancet-figures-tables — Table 1, KM, forest, study-flow diagram
6. lancet-research-in-context — the signature three-part panel (systematic search)
7. lancet-abstract — structured abstract (Findings/Interpretation/Funding) ≤300 words
8. lancet-writing — main-text structure and length; cautious Discussion
9. lancet-ethics — declaration of interests, role of funding, data sharing, equity
10. lancet-submission — preflight + cover letter
11. lancet-rebuttal — after review

lancet-abstract, lancet-research-in-context, and lancet-writing are largely late-stage polish. Do not perfect the abstract before registration and reporting compliance are settled.

Decision shortcuts

• "This is solid but it's a single-centre confirmatory result" → lancet-fit (consider EClinicalMedicine / specialty title)
• "Enrollment started before we registered the trial" → lancet-study-design (a serious problem — flag immediately)
• "We have no CONSORT flow diagram" → lancet-reporting
• "We never did a systematic search of prior evidence" → lancet-research-in-context
• "Our abstract says Results and Conclusions" → lancet-abstract (Lancet uses Findings / Interpretation)
• "We report odds ratios but no absolute risk" → lancet-statistics
• "We didn't state who had final responsibility to submit" → lancet-ethics (role of the funding source)

Worked routing example (illustrative)

A hypothetical multi-country RCT manuscript arrives mid-stream; the router resolves the bottleneck.

Symptoms reported:
  - "We think it's a Lancet paper but we're not sure it changes practice"  -> lancet-fit FIRST
  - "Registration date may be after first enrolment"                       -> lancet-study-design (flag)
  - "Abstract says Results / Conclusions"                                   -> lancet-abstract
  - "No Research in context panel"                                          -> lancet-research-in-context
Resolved order (illustrative):
  lancet-fit -> rung 4, GO
  -> lancet-study-design (confirm prospective registration; reconcile primary outcome)
  -> lancet-reporting (CONSORT + flow diagram)
  -> lancet-statistics -> lancet-figures-tables
  -> lancet-research-in-context -> lancet-abstract -> lancet-writing
  -> lancet-ethics -> lancet-submission -> (after decision) lancet-rebuttal
Gate rule: never start prose polish before lancet-fit clears; the modal outcome is
  rejection without review.

Anti-patterns

• Do not skip lancet-fit and start polishing prose — the modal outcome is rejection without review.
• Do not draft the Research in context panel before the systematic search is actually run.
• Do not generate a rebuttal before the main text is actually revised.
• Do not treat the abstract or panel as optional formatting — they are load-bearing at triage.