PONE-D-21-00660

Design of a patient-centered decision support tool when selecting an organ transplant center

PLOS ONE

Dear Dr. Schaffhausen,

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.

The Section Editor and an Invited Reviewer evaluated the manuscript. There are several aspects of this manuscript which need to be addressed. The Section Editor and the Reviewer agree that the website is providing useful information for patients who are searching for a transplant center. Both also agree that such website is needed. However, such website needs to provide many additional information. The evaluation of the usefulness of the website should include reasons for the choice by the consumer (patient). Consequently, the following points need to be addressed:

The Section Editor's comments:

The informative website about available transplant centers is a very practical and useful tool for patients who are searching for a transplant center. Providing many information such as location, distance, number of transplants, specialized considerations (viral infection, diabetes and others) are alsovery helpful. Possibly, the website is under continuous development and the authors are considering added many more practical information such as the performance, additional services, and even accommodations. All these aspects are promising for the project.

The manuscript needs to address the following points:

The major problem of the report/manuscript about the website: (www.transplantcentersearch.org) is the fact that the authors are describing the functionality of this side without any information about the decision made by users. The entire benefit of this website is by providing name and location of transplant centers, the summary of the number of transplants, and the relative distance for the transplant centers. However, the website is following the rule of state-associated transplant centers, whereas the system is being transformed into the 250-mile zones.

The authors had 684 participants influencing about 26 icon styles and 38 usability testing participants about some improvements to the website. These results are relatively limited and providing readers with no fundamental substance. The authors do not report what decisions were mage based on their website. What information influenced the decision making? What were the decisive points for the selection of specific transplant center? The manuscript does not even evaluate whether participants were transplant patients. Consequently, it is very difficult to evaluate what impact this website made except of intuitive suggestion that this type of website with information about the outcome provide some initial information.

The authors need to combine their website usability with specific decision making by viewers. The description of website development and changes to icon style and other website aspect does not provide sufficient information about the impact on the choice of the transplant center. The data described are very preliminary and need to be further developed into more specific survey and concrete quality-related issues such as waiting time for a transplant, quality of service, availability of support personnel, outcomes of transplant results. All these factors need to be as materials available for transplant center evaluations. While the website informs which center has a shorter waiting time there is no details and therefore this may be insignificant in the context of the major issue to get a transplant.

The manuscript does not provide practical and useful conclusions.

The Reviewer's comments:

The study by Schaffhausen et al describes the development of a website aimed at helping patients choose a transplant center. The study was performed in two stages: first, website icons were tested for various ways of displaying transplant centers as “good” or “bad”, second, various website structure versions were tested for functionality from a user perspective. Leaving out the question about the match between the research question and the scope of the journal, I would say this is a beautifully described study that deserves to be published. It seems backwards that the icon surveys were performed with regular internet users, while useability testing was performed with real waiting list patients. It may also be a politically charged question how an icon design can impact patient’s navigation and ultimate decision making, given that an icon is designed to represent transplant center ranking. None of this, however, should be a serious concern, at least not from my side

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Kind regards,

Stanislaw Stepkowski

Academic Editor

PLOS ONE

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Additional Editor Comments:

The Section Editor and an Invited Reviewer evaluated the manuscript. There are several aspects of this manuscript which need to be addressed. The Section Editor and the Reviewer agree that the website is providing useful information for patients who are searching for a transplant center. Both also agree that such website is needed. However, such website needs to provide many additional information. The evaluation of the usefulness of the website should include reasons for the choice by the consumer (patient). Consequently, the following points need to be addressed:

The Section Editor's comments:

The informative website about available transplant centers is a very practical and useful tool for patients who are searching for a transplant center. Providing many information such as location, distance, number of transplants, specialized considerations (viral infection, diabetes and others) are alsovery helpful. Possibly, the website is under continuous development and the authors are considering added many more practical information such as the performance, additional services, and even accommodations. All these aspects are promising for the project. The manuscript needs to address the following points:

The major problem of the report/manuscript about the website: (www.transplantcentersearch.org) is the fact that the authors are describing the functionality of this side without any information about the decision made by users. The entire benefit of this website is by providing name and location of transplant centers, the summary of the number of transplants, and the relative distance for the transplant centers. However, the website is following the rule of state-associated transplant centers, whereas the system is being transformed into the 250-mile zones.

The authors had 684 participants influencing about 26 icon styles and 38 usability testing participants about some improvements to the website. These results are relatively limited and providing readers with no fundamental substance.

The authors do not report what decisions were mage based on their website. What information influenced the decision making? What were the decisive points for the selection of specific transplant center? The manuscript does not even evaluate whether participants were transplant patients. Consequently, it is very difficult to evaluate what impact this website made except of intuitive suggestion that this type of website with information about the outcome provide some initial information.

The authors need to combine their website usability with specific decision making by viewers. The description of website development and changes to icon style and other website aspect does not provide sufficient information about the impact on the choice of the transplant center. The data described are very preliminary and need to be further developed into more specific survey and concrete quality-related issues such as waiting time for a transplant, quality of service, availability of support personnel, outcomes of transplant results. All these factors need to be as materials available for transplant center evaluations. While the website informs which center has a shorter waiting time there is no details and therefore this may be insignificant in the context of the major issue to get a transplant.

The manuscript does not provide practical and useful conclusions.

The Reviewer's comments:

The study by Schaffhausen et al describes the development of a website aimed at helping patients choose a transplant center. The study was performed in two stages: first, website icons were tested for various ways of displaying transplant centers as “good” or “bad”, second, various website structure versions were tested for functionality from a user perspective. Leaving out the question about the match between the research question and the scope of the journal, I would say this is a beautifully described study that deserves to be published. It seems backwards that the icon surveys were performed with regular internet users, while useability testing was performed with real waiting list patients. It may also be a politically charged question how an icon design can impact patient’s navigation and ultimate decision making, given that an icon is designed to represent transplant center ranking. None of this, however, should be a serious concern, at least not from my side

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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: Yes

Reviewer #2: No

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

Reviewer #1: N/A

Reviewer #2: No

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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: No

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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: The study by Schaffhausen et al describes the development of a website aimed at helping patients choose a transplant center. The study was performed in two stages: first, website icons were tested for various ways of displaying transplant centers as “good” or “bad”, second, various website structure versions were tested for functionality from a user perspective. Leaving out the question about the match between the research question and the scope of the journal, I would say this is a beautifully described study that deserves to be published. It seems backwards that the icon surveys were performed with regular internet users, while useability testing was performed with real waiting list patients. It may also be a politically charged question how an icon design can impact patient’s navigation and ultimate decision making, given that an icon is designed to represent transplant center ranking. None of this, however, should be a serious concern, at least not from my side.

Reviewer #2: The informative website about available transplant centers is a very practical and useful tool for patients who are searching for a transplant center. Providing many information such as location, distance, number of transplants, specialized considerations (viral infection, diabetes and others) are alsovery helpful. Possibly, the website is under continuous development and the authors are considering added many more practical information such as the performance, additional services, and even accommodations. All these aspects are promising for the project. The manuscript needs to address the following points:

The major problem of the report/manuscript about the website: (www.transplantcentersearch.org) is the fact that the authors are describing the functionality of this side without any information about the decision made by users. The entire benefit of this website is by providing name and location of transplant centers, the summary of the number of transplants, and the relative distance for the transplant centers. However, the website is following the rule of state-associated transplant centers, whereas the system is being transformed into the 250-mile zones.

The authors had 684 participants influencing about 26 icon styles and 38 usability testing participants about some improvements to the website. These results are relatively limited and providing readers with no fundamental substance.

The authors do not report what decisions were mage based on their website. What information influenced the decision making? What were the decisive points for the selection of specific transplant center? The manuscript does not even evaluate whether participants were transplant patients. Consequently, it is very difficult to evaluate what impact this website made except of intuitive suggestion that this type of website with information about the outcome provide some initial information.

The authors need to combine their website usability with specific decision making by viewers. The description of website development and changes to icon style and other website aspect does not provide sufficient information about the impact on the choice of the transplant center. The data described are very preliminary and need to be further developed into more specific survey and concrete quality-related issues such as waiting time for a transplant, quality of service, availability of support personnel, outcomes of transplant results. All these factors need to be as materials available for transplant center evaluations. While the website informs which center has a shorter waiting time there is no details and therefore this may be insignificant in the context of the major issue to get a transplant.

The manuscript does not provide practical and useful conclusions.

**********

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Reviewer #1: Yes: Dulat Bekbolsynov

Reviewer #2: Yes: Stanislaw Stepkowski 

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Design of a patient-centered decision support tool when selecting an organ transplant center

PONE-D-21-00660R1

Dear Dr. Schaffhausen,

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.

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Kind regards,

Stanislaw Stepkowski

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

None

Reviewers' comments: