PONE-D-20-11971

Concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship: a cross-sectional study of Mexican patients with rheumatic diseases.

PLOS ONE

Dear Dr. Pascual-Ramos,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: Yes

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4. 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

Reviewer #2: Yes

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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: In this interesting article Pascual Ramos and colleagues investigated the concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship. The article is well written and provides interesting insights in the topic. My major concerns relate to:

-Gender bias: Almost all patients included in all phases of the study are females and although this reflects the prevalence of the included diseases (e.g. SLE, RA), this necessarily hampers the generalizability of the results. This in fact prevents the assessment of whether gender is a factor that should be considered in regression models.

-Imbalance of disease types: SLE and RA account for more that half of the sample so again the question remains on how these results can be generalised to all other diseases that are poorly represented in the sample. Perhaps it would make sense to pool patients by disease groups (e.g. inflammatory arthritis vs connective tissue diseases, ideally by including additional patients to balance the numbers). This would also allow to unmask disease-related differences.

Reviewer #2: The authors found that concordance of autonomy ideal among patients and their rheumatologists positively impacts on the patient-doctor relationship.

The study also revealed that Mexican patients and rheumatologists ideal of autonomy was primarly physician-centered or paternalistic.

This is an interesting study that reveals that the concordance about ideal autonomy improves patient - doctor relationship in Mexican patients with rheumatic diseases.

In literature is reported that patients’ preferences and autonomous decision-making are influenced by demographic variables (with younger ,better educated patients and women being quite consistently found to prefer a more active role in decision making), their experience of illness and medical care, their diagnosis and health status , the type of decision they need to make, the amount of knowledge they have acquired about their condition, their attitude towards involvement, and the interactions and relationships they experience with health professionals. Their preferences are likely to develop over time as they gain experience and may change at different stages of their illness .

I think that this study enriches the knowledgement about clinical decision making in a specific geographic area.

I appreciated methodological steps and interdisciplinary collaboration.

I have not any major or minor remarks.

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Reviewer #1: No

Reviewer #2: Yes: Palma Scolieri

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Concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship: a cross-sectional study of Mexican patients with rheumatic diseases.

PONE-D-20-11971R1

Dear Dr. Pascual-Ramos,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Luca Navarini

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

Reviewer #2: (No Response)

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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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #2: 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

Reviewer #2: 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: Authors properly addressed all issues that have been raised. I have no further comments on the revised version of the manuscript.

Reviewer #2: I confirm my positive feedback about this paper. The article is well constructed and

may be accepted for publication.

Please note that at line 124 it needs add p to “suplementary”

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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

Reviewer #2: Yes: PALMA SCOLIERI