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1
Palliative Medicine, Health
Education Yorkshire and the
Humber, Leeds, UK
2
Department of Respiratory
Medicine, Lunds Universitet,
Lund, Sweden
3
Faculty of Health, University
of Technology Sydney, Sydney,
Australia
4
Department of Palliative
Medicine, University of Hull,
Wolfson Palliative Care Research
Centre, Hull, UK
Correspondence to
Dr Sarika Hanchanale, Palliative
Medicine Department, The Royal
Liverpool Hospital, Liverpool L7
8XP, UK;
​shanchanale@​gmail.​com
Received 19 August 2017
Revised 9 October 2017
Accepted 25 October 2017
To cite: Hanchanale S,
Kerr M, Ashwood P, et al.
BMJ Supportive & Palliative
Care Published Online
First: [please include Day
Month Year]. doi:10.1136/
bmjspcare-2017-001425
Hanchanale S, et al. BMJ Supportive & Palliative Care 2017;0:1–5. doi:10.1136/bmjspcare-2017-001425
Conference presentation in
palliative medicine: predictors of
subsequent publication
Sarika Hanchanale,1 Maria Kerr,1 Paul Ashwood,1 Emily Curran,1
Magnus Ekstrom,2 Sharon Allen,3 David Currow,3 Miriam J Johnson4
Abstract
Objectives  Concerns have been raised about
poor-quality palliative care research and low
publication rate from conference abstracts. The
study objectives: to estimate the publication
rate for European Association for Palliative Care
research conference abstracts (2008) and explore
associated characteristics and to understand
reasons for non-publication.
Methods  Full published papers were searched
to March 2015 (Medline; Pubmed; Google
Scholar) and data extracted: country of origin,
study design/population/topic. Multivariate
logistic regression was used to identify predictors
of publication.  Members of two different
palliative care associations were surveyed to
understand reasons for non-publication. χ2
statistic was used to explore associations with
publication.
Results  Overall publication rate of the 445
proffered abstracts was 57%. In the final model,
publication was more likely for oral presentations
(OR 2.13; 95% CI 1.28 to 3.55; P=0.003), those
from Europe (3.24; 1.09 to 9.56; P=0.033) and
much less likely for non-cancer topics (0.21; 0.07
to 0.64; P=0.006). Funding status, academic
unit or study design were not associated with
publication.
Survey  407/1546 (26.3%) physicians
responded of whom 254 (62%) had submitted
a conference abstract. Full publication was
associated with: oral presentation (P<0.001),
international conference abstracts (P=0.01) and
academic clinicians versus clinicians (P<0.001).
Reasons for non-publication included: low
priority for workload (53%) and time constraints
(43%).
Conclusions  The publication rate was similar
to 2005 clinical conference. Probable quality
markers were associated with publication: oral
presentations selected by conference committee,
international conference abstracts and abstracts
from those with an academic appointment.
Publication was given a low priority among
clinical time pressures.
Research
Introduction
Good-quality research, as well as its
dissemination and implementation, is
vital for evidence-based practice. The oral
and poster presentations at conferences
are an important way of sharing scientific
information before formal publication in
journals. The data presented are limited
by word count and generally have not
undergone the more rigorous peer review
required for full publication. Thus, it can
be difficult to appraise the quality of work
presented at conferences.1 An analysis of
the European Association for Palliative
Care (EAPC) clinical conference in 2005
showed that 43% of abstracts were subse-
quently fully published.2
Our primary aim was to determine the
number of peer-reviewed publications
arising from the abstracts presented at the
EAPC Research Congress Meeting (2008),
to allow at least 5 years for subsequent
publication, and to explore the character-
istics that predicted publication. We also
conducted a survey of members of Associ-
ation for Palliative Medicine (APM; Great
Britain and Ireland) and The Australian &
New Zealand Society of Palliative Medi-
cine (ANZSPM; Australasia) to under-
stand reasons for non-publication.
Methods
Design summary
This was a two stage project: (1) an eval-
uation of published abstracts by searching
the literature for evidence of subsequent
of publications and (2) a cross-sectional
online survey of palliative care physicians
(APM and ANZSPM).
Data collection
The EAPC Congress in 2008 abstracts
were published in Palliative Medicine
Journal.3 Invited and duplicate abstracts
were excluded. The Pubmed, Embase,
1
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Research

Medline and Cochrane database search was conducted

between January and March 2015 to identify peer-re-
viewed publication of each abstract using the title,
name of first and last author by two independent
reviewers.
Published papers were considered to be a match if
the hypothesis, study design and cohort were identical.
The following data, where apparent, were extracted
using a bespoke proforma: presentation type (oral;
poster); year of publication; journal of publication;
country of origin of the abstract, study population,
academic or non-academic unit, topic/design/popula-
tion and funding.
The funding data were graded as unknown, none,
institutional, external or both (institutional and
external) according to statements in the abstract and/
or article. If one of the authors was from University,
we assumed that the work was linked to the academic
unit. Two reviewers examined the full articles and
Figure 1  Preferred Reporting Items for Systematic Reviews
graded the all the data with access to a third in the and Meta-Analyses flow chart: abstracts to publication.
event of disagreement.

Survey of palliative care physicians
The survey was developed using previously published
reasons for low publication rates and the researchers’
own experience.1 4 5 The survey was piloted, then
sent by email to APM and ANZSPM and was short,
anonymous and voluntary (see online supplemen-
tary appendix). Completion of the survey was taken
as complied consent. The survey was adminis-
tered through the online platform Qualtrics, Provo,
Utah, USA.
Analysis
Data were tabulated using descriptive statistics.
Congress abstract study variables associated with
publication were analysed using univariable and multi-
variable logistic regression. Variables to be evaluated
were selected based on subject matter knowledge: type
of presentation; region; academic affiliation; funding;
design; topic; population.6 Associations were presented
as ORs with 95% CIs. Analyses were performed using
Stata V.14.2 (StataCorp). Survey variables associated
with publication were analysed using χ2 test, produced
in the Qualtrics report.
Results
Overall, 53.3% of abstracts were published as a full
article. The flow chart (figure 1) shows how the
abstracts were included and excluded in the study.
Most articles were published in palliative care journals,
most commonly: the Journal of Pain and Symptom
Management (12.7%), Palliative Medicine Journal
(10.3%) and Supportive Care in Cancer (9.5%).
Out of 445 abstracts, 273 (61.3%) presenters had
links to an academic unit. Funding was unknown
for 271 (61%), of which only 9 (2%) were speci-
fied as unfunded. Institutional or external funding
was stated for 29 (6.5%) and 122 (27.5%), respec-
tively. Combined external and institutional funding
was noted in 13 (2.9%). Most study populations
were people with cancer or described as palliative
care patients, 135 (30.3%) and 163 (36.6%) ,respec-
tively. Only 34 (7.6%) of the studies were of people
with non-cancer conditions. The most common study
design was observational (177, 40%). There were 77
(17.3%) qualitative and 57 (12.8%) reviews, but only
31 (7%) were clinical trials. The countries with more
than 10 abstracts with its publication number and
percentage are seen in (figure 2).
Regression analysis
Table 1 shows the univariable analysis, and table 2
shows the final multiple regression model. In the final
model, only type of presentation and region signifi-
cantly increased the OR of future publication; oral
presentations more likely than poster (OR 2.13; 95%
CI 1.28 to 3.55; P=0.003) and European submis-
sions more likely than Middle Eastern and African
(OR 3.24; 1.09 to 9.56; P=0.033). Abstracts about
non-cancer topics were less likely to be published (OR
0.21; 0.07 to 0.64; P=0.006). Of note, funding status,
academic unit or study design was not associated with
publication.
Survey
The total response rate of survey was 407/1546
(26.3%). Out of 407 respondents, 275 (67.6%) had
presented an abstract at a (any) conference before
2013. Of these, only 100/275 (37.6%) published
their abstract as a full paper. Publication was associ-
ated with oral (P<0.001) or international conference
presentation (P=0.01) and those submitted by clinical
academics versus clinicians (P<0.001).

2 Hanchanale S, et al. BMJ Supportive & Palliative Care 2017;0:1–5. doi:10.1136/bmjspcare-2017-001425

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Research

Table 1  Univariable analysis

Univariable analysis
Variable OR 95% CI P value
Type of presentation
 Poster presentation Reference
 Oral presentation 1.76 1.1 to 2.8 0.018
Region
Middle East and Africa Reference
Americas 2.04 0.64 to 6.49 0.229
Asia-Pacific 3.2 0.52 to 19.84 0.212
Europe 3.55 1.23 to 10.32 0.019
Figure 2  Publication rate by countries with more than 10 Unit
submitted abstracts.  Non-academic unit Reference
 Academic unit 1.19 0.81 to 1.76 0.367
Funding
The overwhelming majority of reasons given Not funded Reference
for non-publication related to time pressures and Funded 1.01 0.68 to 1.48 0.980
resources: low priority (53.2%); time constraints Design
(43%); lack of support/resources (20.9%). Nearly Evidence synthesis Reference
one-third were not submitted because the work was Clinical quantitative (RCT, 1.64 0.91 to 2.95 0.100
preliminary or ongoing (32%). Only a minority were observational)
not published due to rejection of a submitted manu- Clinical mixed 1.57 0.64 to 3.88 0.325
script (6.3%); therefore, most unpublished were never Clinical qualitative 1.56 0.78 to 3.11 0.205
submitted. Service development 1.16 0.54 to 2.48 0.708
Other (other, basic science, 1.41 0.55 to 3.64 0.473
methodological)
Discussion
Topic
We found that just over one-half of abstracts
Symptoms Reference
presented at one of palliative care’s main inter-
Non-cancer 0.27 0.09 to 0.78 0.016
national research conferences were subsequently
Education and service 0.80 0.42 to 1.53 0.506
published in full. Oral presentations and those from delivery
Europe were more likely to be published. The survey
Research 1.09 0.67 to 1.79 0.506
indicated that higher-quality work (oral, interna-
Ethics 1.17 0.41 to 3.34 0.765
tional, academically supported) was more likely to
Psychology 0.79 0.38 to 1.63 0.526
be published.
Medical sociology 0.47 0.13 to 1.71 0.251
Population
Publication rate
Adult patients: cancer Reference
The publication proportion was greater than the clin- Adult patients: non-cancer 0.49 0.23 to 1.07 0.074
ical conference (2005), but the research conference Adult patients: diagnosis 1.01 0.23 to 1.07 0.962
may attract more delegates with academic support or mixed/unspecified
interest. Paediatric 2.39 0.24 to 23.7 0.453
In 2008, a Cochrane review found a similar esti- Informal caregiver 1.6 0.46 to 5.57 0.460
mated publication rate at 9 years of 52.6%.7 Simi- Healthcare professionals 1.87 0.80 to 4.37 0.151
larly, the study that analysed the publication rate of Mixed study participants 1.46 0.75 to 2.85 0.261
oncology conference abstracts found the publication Other 0.80 0.28 to 2.25 0.673
rate of 51.2%.8 RCT, randomised controlled trial.
Notably, only 7% of EAPC 2008 abstracts were
of randomised controlled trials (RCTs), one-third of
which were small phase II trials (32.8% trial)); prelim- Academic support
inary or ongoing work is likely to be more difficult to A review of palliative care publications between 1993
publish.4 This assumption is supported by the survey; and 2013 showed that most were from universities
one-third of abstracts were not submitted for publi- or units linked to universities.11 Our survey found a
cation because the work was preliminary/ongoing. strong association between publication and doctors
The paucity of RCTs compared with observational with an academic appointment, although the EAPC
studies submitted to palliative care journals has been 2008 study did not. ‘Time pressure’ is a common
noted, although reported palliative care RCTs are reason for non-publication.1 4 12 ‘Lack of time’ was the
increasing.6 9 10 main barrier to research participation (80%) cited by

Hanchanale S, et al. BMJ Supportive & Palliative Care 2017;0:1–5. doi:10.1136/bmjspcare-2017-001425 3

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Research

Table 2  Multivariable analysis

subsequently published as full papers. Better-quality
work (international, oral, academic) was more likely to
Multivariable analysis
be published. Clinical palliative physicians feel unsup-
Outcome: Variables and ported with regards to time or priorities to publish
published references OR 95% CI P value
data beyond conference presentation. Academic
Presentation Reference: poster presentation centres play an important role in supporting palliative
type
care units to be research active and contribute to the
Oral presentation 2.13 1.28 to 3.55 0.003
evidence base.
Region Reference: Middle East and Africa
1. Americas 1.55 0.47 to 5.08 0.468 Acknowledgements  To Ben Fry and Dawn Wood, Hull York
2. Asia Pacific 2.51 0.39 to 16.21 0.332 Medical School for help with the Qualtrics Survey; to all
clinicians who responded and for the assistance of Australian
3. Europe 3.24 1.09 to 9.56 0.033
and New Zealand Society of Palliative Medicine and the
Topic Reference: symptoms (including end of life care) Association for Palliative Medicine with the survey.
1. Non-cancer 0.21 0.07 to 0.64 0.006 Contributors  SH had the concept; SH, MJJ, EC, MK, PA
2. Education and 0.80 0.41 to 1.56 0.525 and DC designed the study and survey; SH, MK,EC, PA
service delivery and SA searched and extracted data; SH, MJJ, SA and DC
3. Research and 1.22 0.73 to 2.03 0.439 conducted the survey; ME conducted the regression analysis;
audit all contributed to data interpretation; SH wrote the first draft
and all contributed to writing subsequent drafts and approved
4. Ethics 1.04 0.35 to 3.08 0.943
the final manuscript.
5. Psychology 0.80 0.38 to 1.69 0.574
Competing interests  None declared.
6. Medical sociology 0.34 0.08 to 1.30 0.116
Patient consent  Detail has been removed from this case
description/these case descriptions to ensure anonymity. The
French palliative care professionals.13 Approximately editors and reviewers have seen the detailed information
available and are satisfied that the information backs up the
one-half of our survey respondents cited a low priority case the authors are making.
and time constraint as reasons for non-publication. Ethics approval  The Hull York Medical School.
However, palliative care units with research funding
Provenance and peer review  Not commissioned; externally
streams through grant funding, national research infra- peer reviewed.
structures or through the commitment of the unit’s Data sharing statement  Data are available only for the authors.
senior management and board are able to successfully
participate in good-quality research.14–16
© Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2017. All rights reserved.
Funding No commercial use is permitted unless otherwise expressly
A relationship between external funding and quality granted.
of study has been noted in supportive and palliative
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5
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Conference presentation in palliative

medicine: predictors of subsequent
publication
Sarika Hanchanale, Maria Kerr, Paul Ashwood, Emily Curran, Magnus
Ekstrom, Sharon Allen, David Currow and Miriam J Johnson

BMJ Support Palliat Care published online November 10, 2017

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