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Figure.
Conflicts of Interest (COIs) for Oral Presentations at the 2015 Annual Meeting of the American Society of Clinical Oncology (ASCO)
Conflicts of Interest (COIs) for Oral Presentations at the 2015 Annual Meeting of the American Society of Clinical Oncology (ASCO)

Reading ability was 4 words per second or below in 62% of presentations and above 4 words per second in 38% of presentations.

1.
Singh  H, Spitzmueller  C, Petersen  NJ, Sawhney  MK, Sittig  DF.  Information overload and missed test results in electronic health record-based settings.  JAMA Intern Med. 2013;173(8):702-704.PubMedGoogle ScholarCrossref
2.
Trauzettel-Klosinski  S, Dietz  K; IReST Study Group.  Standardized assessment of reading performance: the New International Reading Speed Texts IReST.  Invest Ophthalmol Vis Sci. 2012;53(9):5452-5461.PubMedGoogle ScholarCrossref
3.
Ziefle  M.  Effects of display resolution on visual performance.  Hum Factors. 1998;40(4):554-568.PubMedGoogle ScholarCrossref
4.
American Society of Clinical Oncology. ASCO Updates Conflict of Interest Policies. https://connection.asco.org/magazine/features/asco-updates-conflict-interest-policies. Accessed July 20, 2016.
Research Letter
December 2016

Effect of the American Society of Clinical Oncology’s Conflict of Interest Policy on Information Overload

Author Affiliations
  • 1School of Medicine, Oregon Health & Science University, Portland
  • 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland
  • 4Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
  • 5Center for Health Care Ethics, Oregon Health & Science University, Portland
 

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Oncol. 2016;2(12):1653-1654. doi:10.1001/jamaoncol.2016.2706

More information than can be managed in the time allotted is considered information overload.1 Prior evidence suggests that average reading comprehension in English is 228 words per minute (3.8 words per second).2 Proofreading can be performed at approximately 200 words per minute (3.3 words per second).3 When a large volume of text is presented for a short period at which readers have to exceed these speeds, the ability of readers to comprehend is in doubt.

The American Society of Clinical Oncology (ASCO) mandates the disclosure of financial conflict of interest (COI) in a slide at the start of oral presentations at their annual meeting. Between the 2014 and 2015 meetings, the COI policy changed, asking speakers to disclose not only relevant financial conflicts but also any financial relationships (deemed relevant or not).4 We sought to examine whether this policy change is associated with increased information overload in COI slides.

Method

We examined videos of presentations from 2014 to 2015 from the ASCO virtual meeting library (http://meetinglibrary.asco.org/), a database of ASCO annual meetings, organized by track—1 of 15 to 30 themes, such as breast cancer, lung cancer, or tumor biology. Within each track, educational sessions pertain to updates in management or care, whereas oral sessions present original research.

We noted the duration the COI slide was visible and the number of COI disclosure slides for up to 5 presentations in the oral and educational sessions for each track. Videos were not screened before inclusion. Welcome presentations were excluded.

We used the video player time stamp for timing. Time was noted when the standard ASCO COI disclosure slide was displayed and stopped. Some slides had a fade-out transition, and time was noted when the content was no longer clearly visible. Nonstandard disclosure slides were excluded.

Word count was based on Microsoft Word’s count function. The title of the disclosure slide and standard text were excluded.

Descriptive statistics were performed using STATA statistical software, version 12.0 (StataCorp), and R, version 3.2.2. The comparison test was the Wilcoxon rank sum test. Four words per second was set as the threshold for information overload to provide a generous estimate. This investigation of meeting presentations was exempt from institutional review board approval.

Results

We examined 469 presentations given by 458 speakers. The number of speakers with at least 1 COI disclosure increased from 124 of 242 (51.2%) in 2014 to 151 of 216 (69.9%) in 2015 (odds ratio, 2.21; P < .001). The median number of reported COI disclosures increased from 1 (interquartile range [IQR], 0-3) in 2014 to 3 (IQR, 0-8) in 2015 (P < .001). The duration of the COI slide decreased slightly from 6 (IQR, 4-8) to 5 (IQR, 2-9) seconds (P = .02), and the number of words included increased from 7 (IQR, 7-12) to 13 (IQR, 7-25) (P < .001). The median number of words per second increased from 1.5 to 3.2 per second from 2014 to 2015 (P < .001). In 2014, no differences were found in the number of COI disclosures between education and oral sessions. In 2015, oral sessions had more conflicts (median, 5.5; IQR, 0.5-11.5) than educational sessions (median, 3; IQR, 0-6) (P = .004).

The Figure shows a waterfall plot of words per second in 2015. The baseline is set as 4 words per second, an optimistic estimate of maximum reading ability. In 2014, a total of 37 of 248 presentations (14.9%) had information overload, whereas in 2015 this number increased to 83 of 221 (37.6%) (P < .001). As a sensitivity analysis, we compared 2015 and 2013 and reached similar conclusions.

Discussion

We found that the change in policy from disclosure of relevant to all financial COIs increased disclosed COI and information overload at ASCO annual meetings. Of concern, 83 of 221 presentations (37.6%) at last year’s ASCO meeting had COI disclosure slides that were displayed at a speed so fast that they exceeded the range of comprehension for most readers. For COI disclosure to be meaningful, it must be able to be read and processed. We also found that 124 of 242 speakers (51.2%) had at least 1 financial COI, and this number increased to 151 of 216 (69.9%) when all financial ties were disclosed as opposed to only those deemed relevant.

Our findings raise concern about whether current disclosure protocols constitute meaningful disclosure. The solution would be to extend the time of the disclosure slide so that no slide exceeds established limits of reading speed. Further investigation is needed on audience ability to process COI slides at professional meetings if disclosure is the major objective.

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Article Information

Corresponding Author: Vinay Prasad, MD, MPH, Department of Hematology and Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (prasad@ohsu.edu).

Published Online: August 25, 2016. doi:10.1001/jamaoncol.2016.2706.

Author Contributions: Drs Boothby and Prasad had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Boothby, Cetnar, Prasad.

Acquisition, analysis, or interpretation of data: Boothby, Wang, Prasad.

Drafting of the manuscript: Prasad.

Critical revision of the manuscript for important intellectual content: Boothby, Wang, Cetnar.

Statistical analysis: Wang.

Study supervision: Cetnar, Prasad.

Conflict of Interest Disclosures: None reported.

References
1.
Singh  H, Spitzmueller  C, Petersen  NJ, Sawhney  MK, Sittig  DF.  Information overload and missed test results in electronic health record-based settings.  JAMA Intern Med. 2013;173(8):702-704.PubMedGoogle ScholarCrossref
2.
Trauzettel-Klosinski  S, Dietz  K; IReST Study Group.  Standardized assessment of reading performance: the New International Reading Speed Texts IReST.  Invest Ophthalmol Vis Sci. 2012;53(9):5452-5461.PubMedGoogle ScholarCrossref
3.
Ziefle  M.  Effects of display resolution on visual performance.  Hum Factors. 1998;40(4):554-568.PubMedGoogle ScholarCrossref
4.
American Society of Clinical Oncology. ASCO Updates Conflict of Interest Policies. https://connection.asco.org/magazine/features/asco-updates-conflict-interest-policies. Accessed July 20, 2016.
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