PONE-D-19-16906

Recommendations of older adults on how to use the PROM ‘TOPICS-MDS’ in

healthcare conversations: a Delphi study

PLOS ONE

Dear Prof Peo-Littel,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

I have read the manuscript and I agree with the comments made by the reviewer. Please consider these comments very carefully and make it very clear why and if you dont make changes as a result.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

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Reviewer #1: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I commend the researchers / authors for their commitment to the health of older adults. However, there are a number of questions that need to be answered.

- the tool is titled for older adults and informal caregivers survey - these are two distinct population groups. Was there a difference in the findings?

- if this tool is useful then the need to educate health care professionals is important and needs to be addressed. How might this be conducted?- there is no discussion of the implications of this study for the education of health care professionals specific to the use of this tool.

- was this a Delphi study, or was it simply three focus groups with specific intentions? I would suggest the former as it does appear that a consensus was sought. It does not appear from the reported findings that a group consensus was achieved, as different objectives were identified (lines 126-131).

- focus groups are an effective strategy for some qualitative work but the nature of some of the group members may prevent the views of others from being heard. This is inconsistent with the Delphi process.

- how was the decision made regarding culturally diverse backgrounds and low education (lines 116-118; 134-135)? Define middle level participants please.

- the age of 50 appears quite a young old age and implies that all adults >50 have the same needs.

- line 235, what does "online panel" mean in table 1 and used in other lines eg. line 134, line 420?

- how is the inherent bias addressed if participants with culturally diverse backgrounds and low education were solely in focus group lines 134-135? This influences the credibility of the quantitative results.

- if the participants identified additional topics (lines 59-60) then is the topics tool actually useful? I would suggest perhaps not. How might the authors respond or acknowledge this point?

- how was the qualitative data actually analyzed? The authors identify that content analysis was conducted (line 56) but provide no description of the process.

- the term "patient" is often used e.g. lines 365, 370, however, the study was not done with patients. This is a limitation that is not explored by the authors.

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Reviewer #1: No

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PONE-D-19-16906R1

Recommendations of older adults on how to use the PROM ‘TOPICS-MDS’ in healthcare conversations: a Delphi study

PLOS ONE

Dear  Prof Perl-Littel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

I think it is getting there could you just answer my questions and update the manuscript. 

We would appreciate receiving your revised manuscript by 12 October 2019. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Andrew Soundy

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Can I just check when I have done Delphi I have used quantative stats including Kendalls W and the McNemar test to verify items selected – I used a modified Delphi Okoli and Pawlowski, 2004 – but I wanted to check why you have not used any stats?

Also Qualitative section page 10 I would like some more details for the reader.

The reader will need to know your paradigmatic position if you are presenting qualitative data so please add this. E.g., for the purpose of the qualitative analysis we have positioned ourselves as subtle-realists. This is important because it tells the reader what you present the information as you do eg., for me as a subtle realist I may include numbers of people which identify with each statement or theme.

For the themes can you consider if there is any sub-themes

Line 292-332

Some readers will want to have a little more detail: e.g., when you mention limitations in daily life – what do you mean? I would expand the detail e.g.,

Some participants (x/x, xx%) wanted to discuss their limitations in daily life. Limitations included; (a) help understanding how to navigate the stairs (x/x, xx%), (b) assistance in preparing meals (x/x, xx%)

Think about a standard way to introduce the theme

identification of sub-themes focus on x most prevalent sub-themes

e.g.,

Functional limitations

This theme include X sub-themes: (a) the ability to walk to the shops – then include detail as above

-also quotes can more detail so in analysis say how you identify individuals e.g., individuals will be identified by gender, age and educational level (school S, university U, higher degree;HD) an example of this would be (PM49U; meaning male participant, 49 years, University level education)

This is just a suggestion but something like this given would just help the reader understand that the process was robust and considered. You could include something in a supplementary file instead just to reveal the process

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: While some English editing would be useful, the current version is acceptable. I would suggest that the authors be advised of the contribution that an English editor might make to the quality of a manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Recommendations of older adults on how to use the PROM ‘TOPICS-MDS’ in healthcare conversations: a Delphi study

PONE-D-19-16906R2

Dear Dr. Ruth Pel-Littel,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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PLOS ONE

Additional Editor Comments (optional):

Thank you for making the updates to this manuscript.

Reviewers' comments:

The reviewer suggested acceptance of the previous version so the manuscript was not sent out to them.