Dr Katherine Sleeman, NIHR Clinician Scientist at the Cicely Saunders Institute, King’s College London, UK
Is there a problem with gender bias in academic palliative care? This was the question I pondered at the 2016 European Association for Palliative Care (EAPC) World Research Congress in Dublin. Sitting in the audience, I was surrounded by women. But looking up at the Plenary stage, I saw mainly men. A tally of numbers of men and women speaking revealed that while most of the speakers in Free Communication sessions were women (these speakers are chosen anonymously on the merit of their submitted abstracts), the proportion of women fell dramatically for the Parallel sessions (invited talks, which are more prestigious) and even more so for the Plenary talks (the most prestigious of all). A quick Chi squared test showed that these results were unlikely to have occurred by chance. The leaky pipeline, a term used to describe the attrition of women as they progress in academia, seems to be a valid concern in palliative care.
We published these results in BMJ Supportive and Palliative Care 1 (by luck the publication date coincided with International Women’s Day), and promoted them widely. The response from fellow academics, both men and women, has been phenomenal. But most encouraging of all has been the response from the EAPC itself. While it might have been easy to ignore or dismiss the data, the EAPC has engaged wholeheartedly (for example, by inviting me to write this blog). I was delighted to learn from Christoph Ostgathe, Chair of the 2017 EAPC World Congress Scientific Committee in Madrid, that our data had been read and discussed within the EAPC. What’s more, changes to the abstract submission process have already been made such that information on gender will now be routinely collected, facilitating analysis of those submitting abstracts and those accepted for presentation.
Of course, monitoring the gender of abstract submitters only addresses the earlier stages of the ‘pipeline’. How do we improve representation of women at the highest level? We do not currently know the reasons for the small number of women giving Plenaries at EAPC. Self-selection, whereby women are more likely than men to decline invitation to give talks, has been described in other specialties. Reasons for refusals to give Plenaries at EAPC conferences should be explored, followed by introduction of steps to increase acceptance rates.
However, an alternative explanation for the low number of women giving Plenaries is bias, either conscious or unconscious. While it may not feel comfortable to address this question, it is essential that we do. Simple interventions have been shown to be effective in reducing bias. For example Scientific Organising Committees that are gender-balanced are more likely to invite women to give prestigious talks, and the EAPC must continue to ensure that this is the case.
The theme of the recent conference in Madrid was ‘Progressing Palliative Care’, referring to the progress we need to make both as a discipline and as an organisation. Fittingly, four of the six Madrid Plenaries were given by women, the largest proportion in recent years by some margin. We must hope that this is not a blip, but a sustained trend towards greater visibility of women. But we must also recognise that other biases may be present and these too need to be explored and addressed. For example, palliative care is a multidisciplinary endeavour but the majority of EAPC Plenary speakers over the past six years have been physicians. This is particularly the case for the biennial research congresses: all plenary speakers in 2012, 2014 and 2016 have been physicians.
Our patients will not be best served if only a proportion of the academic palliative care community is recognised for its work at the highest level. We have a duty to our patients to ensure equality of opportunity. The recognition and engagement with this issue, as demonstrated by the EAPC, is an encouraging and necessary first step.
Reference and Links
- Sleeman KE, Koffman J, Higginson IJ Leaky pipeline, gender bias, self-selection or all three? A quantitative analysis of gender balance at an international palliative care research conference. BMJ Supportive & Palliative Care Published Online First: 07 March 2017. doi: 10.1136/bmjspcare-2016-001211.
- Read more from Katherine Sleeman on the EAPC Blog.
- Follow Katherine Sleeman on Twitter @kesleeman
Read more posts relating to the 15th EAPC World Congress in Madrid on the EAPC Blog.