Responsible use of large language models in manuscript authorship, peer review, and editorial processes: a Delphi consensus among editors-in-chief of anaesthesia and pain medicine journals (RULE-AP)

Large language models (LLMs) are useful tools in academic publishing for authors, reviewers and editors, but their use must be guided by ethics, legality, transparency and accountability.

LLMs may assist with limited editorial and authorial tasks provided their use is fully disclosed and all outputs are verified by humans.

LLMs are inappropriate for generating original or ideative content, which should remain a strictly human responsibility.

LLMs must not generate data, references, conclusions or entire manuscripts, nor be used for editorial decisions or peer-review reports.

Concerns: 'hallucinations', erosion of critical skills, confidentiality breaches, and proliferation of low-quality LLM-generated manuscripts.