Social support for breast cancer patients in the occupied Palestinian territory

Mona I. A. Almuhtaseb; Francesca Alby; Cristina Zucchermaglio; Marilena Fatigante

doi:10.1371/journal.pone.0252608

Peer Review History

Original SubmissionNovember 24, 2020
8 Mar 2021 Decision Letter - Yann Benetreau, Editor PONE-D-20-36979 Social support for breast cancer patients in the occupied Palestinian territory. PLOS ONE Dear Dr. Alby, 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. Although Reviewer 1 recommends publication, and both reviewers gave positive comments on your manuscript, Reviewer 2 requested several clarifications about the interpretation of the data or how they support the conclusions. Please submit your revised manuscript by Apr 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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. 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). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Sincerely, Yann Benetreau, PhD Senior Editor, PLOS ONE Journal Requirements: Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 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 ****** 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 ****** 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: This is an excellent article! It throws light on a Palestinian population living under occupation and difficult conditions. It gives information about how women cope with breast cancer under such circumstances, but also gives information about of how women in general cope with breast cancer. The results are therefore relevant also for other populations. - The analysis is well done, and the background (theory and previous literature) is relevant. Regarding question 2 (above): (Statistical analysis), I answered "yes" as the qualitative analysis is good. There are, of course, no statistical analyses in a qualitative investigation. Regarding question 3 (above): (Whether all data are available), - I also anwered "yes", as all relevant data seem to be analysed and sufficiently reported. Needless to say: one cannot, and should not, for ethical reasons, report absolutely all data in a qualitative report. I suggest only these corrections: On page 17 a name, "Nadia" is mentionned. That should be omitted, and only the initial "N" should be used (as "N" is used for this informant a few sentences earlier in the manuscript. - In another place "Su" appears as what looks like a name. - That too should perhaps be shortened to just "S". Reviewer #2: The article covers an important topic, however the paper needs considerable revision to be of publishable quality. One of the main (major) issues with the paper is that the authors do not adequately engage with the data presented through quotes; some statements are made without being adequately supported or explained. They may be true, but need more explanation and evidence from the authors, for example the issue of breast cancer being stigmatized. There also needs to be more thorough engagement with the literature in the discussion section. The authors compare the findings about husband support with others in the Arab world, but in their discussion there is an implicit assumption that 'Arab' culture is homogeneous, which is not the case, and cultures within any place are also not static. More specific comments: 1) the transition from the introduction to the objectives could be improved by making the case as to why this study is important in Palestinian context 2) objectives should be in introduction rather than materials and methods; objectives also need to be written more clearly, especially first line 3) line 141 part about literature that 'gave voice' is a bit of an odd statement and perhaps better to say what methods they drew on 4) line 148, incorrect statement about Beit Jala, it is one of the major government hospitals in the West Bank providing oncology services but not the only one 5) line 158, not clear what is meant by security and travel as the justification. Is this for the researchers coming from abroad and limitations on their stay? Better to clarify 6) justification needs to be provided for inclusion criteria, especially 3 and 4. In local context, verbal consent is often deemed appropriate by IRB and ethical review committees, why did researchers insist on signed consent? 7) line 167 needs to be explained further 8) line 180-'adherence to research' odd wording 9) line 193, what was rendered sufficient? 10) line 215, not clear if according to literature or the women interviewed 11) line 227-228 where authors state 'attributed to young age and marital status"- it is not clear what is meant and this should be explained more, examples from the data would also be useful. 12) line 229, the statement makes it seem like all women stated they had no support from those outside family, but quotes later on contradict this (e.g. extracts 8 and 9) 13) for discussion of woman whose husband abandoned her, the quote on line 355 also states he comes once a month. It is a bit confusing. 14) beginning line 358: authors jump to loss of work, the transition is abrupt 15) paragraph beginning line 369, authors use N. and then Nadia, better to stick to one or the other and maybe initial for consistency, and ethical/privacy considerations. 16) same participant as above, authors state she didn't tell her family and then talk about support from friends. Were there family members who knew about her diagnosis and not support her? it is not clear 17) statement beginning on line 396 about family playing key role. This may be true, but authors should support through examples from study or references in the literature. 18) lines 437-439, authors talk about lack of reliable information. From whom? The internet or is this more specific to Palestinian context? It reads as if it is more specific to Palestinian context, but at the same time it is not really explained. The references to unreliable information in Arabic on the internet would not limit this issue to Palestinian context. 19) line 442, what negative impact? Explain. 20) line 468, not clear how explanation going back to political context explains centrality of husband as support provider. It is not clear and not convincing from the argument. Also, why should we assume that husbands won't be supportive? 21) statement that breast cancer is stigmatized needs to be explained further. 22) for ethical considerations, were patients also assured that their participation (or not) would not affect their access to treatment? 23) Authors used an inductive approach, did this impact what kinds of support were identified? Were there other forms of support that were not identified during this approach? Important to discuss limitations of analytical approach as well 24) the manuscript can use some copy editing, some use of language reads as a bit odd. ****** 6. 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: Yes:** Torill Christine Lindstrøm Reviewer #2: 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.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. 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Revision 1
17 Mar 2021 Author Response Response to Reviewers In what follows we outline the main changes that we have made to our manuscript by answering to each of the reviewers’ requests. As suggested, we have tracked the changes made to our original submission. We provide also another file that shows the changes made by an English proofreader. We also provide a final, clean version. Reviewer #1: This is an excellent article! It throws light on a Palestinian population living under occupation and difficult conditions. It gives information about how women cope with breast cancer under such circumstances, but also gives information about of how women in general cope with breast cancer. The results are therefore relevant also for other populations. - The analysis is well done, and the background (theory and previous literature) is relevant. Regarding question 2 (above): (Statistical analysis), I answered "yes" as the qualitative analysis is good. There are, of course, no statistical analyses in a qualitative investigation. Regarding question 3 (above): (Whether all data are available), - I also answered "yes", as all relevant data seem to be analysed and sufficiently reported. Needless to say: one cannot, and should not, for ethical reasons, report absolutely all data in a qualitative report. I suggest only these corrections: On page 17 a name, "Nadia" is mentioned. That should be omitted, and only the initial "N" should be used (as "N" is used for this informant a few sentences earlier in the manuscript. - In another place "Su" appears as what looks like a name. - That too should perhaps be shortened to just "S". Changed as suggested. Reviewer #2: The article covers an important topic, however the paper needs considerable revision to be of publishable quality. One of the main (major) issues with the paper is that the authors do not adequately engage with the data presented through quotes; some statements are made without being adequately supported or explained. They may be true, but need more explanation and evidence from the authors, for example the issue of breast cancer being stigmatized. There also needs to be more thorough engagement with the literature in the discussion section. The authors compare the findings about husband support with others in the Arab world, but in their discussion there is an implicit assumption that 'Arab' culture is homogeneous, which is not the case, and cultures within any place are also not static. More specific comments: 1) the transition from the introduction to the objectives could be improved by making the case as to why this study is important in Palestinian context 2) objectives should be in introduction rather than materials and methods; objectives also need to be written more clearly, especially first line 3) line 141 part about literature that 'gave voice' is a bit of an odd statement and perhaps better to say what methods they drew on 1-2-3: Objectives have been moved in the introduction and partially reformulated. In order to making a case for why the study is important, we added few lines about cancer incidence in the Palestinian territory and the relevance of studying coping strategies under these local difficult circumstances (being under occupation) . In what used to be line 141 “gave voice” has been erased and the line rephrased. Reference to the importance of local culture (addressed by Rev2 at the beginning of this letter) and culturally sensitive studies has been added at the end of the introduction. 4) line 148, incorrect statement about Beit Jala, it is one of the major government hospitals in the West Bank providing oncology services but not the only one Correction made 5) line 158, not clear what is meant by security and travel as the justification. Is this for the researchers coming from abroad and limitations on their stay? Better to clarify Clarification added 6) justification needs to be provided for inclusion criteria, especially 3 and 4. In local context, verbal consent is often deemed appropriate by IRB and ethical review committees, why did researchers insist on signed consent? Few lines of explanation have been added. Verbal consent was asked and followed by a written consent that also provided the opportunity to give the patients written information about the research and researchers’ contacts 7) line 167 needs to be explained further This line has been eliminated 8) line 180-'adherence to research' odd wording Rephrased 9) line 193, what was rendered sufficient? Clarification added 10) line 215, not clear if according to literature or the women interviewed Clarification added 11) line 227-228 where authors state 'attributed to young age and marital status"- it is not clear what is meant and this should be explained more, examples from the data would also be useful. This statement has been rephrased and moved later on in the discussion section. 12) line 229, the statement makes it seem like all women stated they had no support from those outside family, but quotes later on contradict this (e.g. extracts 8 and 9) Rephrased 13) for discussion of woman whose husband abandoned her, the quote on line 355 also states he comes once a month. It is a bit confusing. The interviewee states clearly that their marriage is finished. She still meets the husband occasionally but without having the feeling of a real communication between them 14) beginning line 358: authors jump to loss of work, the transition is abrupt A line that reconnects with the financial support topic has been added 15) paragraph beginning line 369, authors use N. and then Nadia, better to stick to one or the other and maybe initial for consistency, and ethical/privacy considerations. Changed in N. 16) same participant as above, authors state she didn't tell her family and then talk about support from friends. Were there family members who knew about her diagnosis and not support her? it is not clear Rephrased. (She did not tell her diagnosis to the family). 17) statement beginning on line 396 about family playing key role. This may be true, but authors should support through examples from study or references in the literature. The statement has been moved after extracts 18,19,20 that provide evidence for it 18) lines 437-439, authors talk about lack of reliable information. From whom? The internet or is this more specific to Palestinian context? It reads as if it is more specific to Palestinian context, but at the same time it is not really explained. The references to unreliable information in Arabic on the internet would not limit this issue to Palestinian context. Specification added 19) line 442, what negative impact? Explain. Few lines of explanation have been added 20) line 468, not clear how explanation going back to political context explains centrality of husband as support provider. It is not clear and not convincing from the argument. Also, why should we assume that husbands won't be supportive? Explanation added (socio-political restriction to mobility obstruct access to both the health care system and the social support networks such as the extended family and other members of the nuclear family). A previous paragraph of the discussion section describes how in the literature on Arab countries the role of the husband as a companion and caregiver of women with breast cancer is controversial, picturing often the husband as a non supporting source. 21) statement that breast cancer is stigmatized needs to be explained further. Main results of the studies quoted on this topic are reported. 22) for ethical considerations, were patients also assured that their participation (or not) would not affect their access to treatment? Yes. Moreover, several patients already completed treatments. 23) Authors used an inductive approach, did this impact what kinds of support were identified? Were there other forms of support that were not identified during this approach? Important to discuss limitations of analytical approach as well Limitations and reference to other analytical approaches have been added 24) the manuscript can use some copy editing, some use of language reads as a bit odd. The manuscript has been proofread by a fluent English speaker and changes have been made. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0252608.r002
14 Apr 2021 Decision Letter - Weeam Hammoudeh, Editor PONE-D-20-36979R1 Social support for breast cancer patients in the occupied Palestinian territory. PLOS ONE Dear Dr. Alby, 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. Please submit your revised manuscript by May 29 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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. 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). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Weeam Hammoudeh Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): The authors have revised and improved the manuscript substantially. There are a few things in the text. The following sentence is not very clear. Framing the issue of willingness to go doesn't fully reflect the reality. Also rather than saying 'should go through', 'would go through' is more suitable, since there is a value judgement in should, and I doubt what the others are trying to say is that this should be the case but rather that it is likely to be the case. 478 Every Arab-Palestinian citizen, who is willing to go to the occupied Jerusalem or move to 479 the West Bank, should go through military checkpoints for inspection. Going through these 480 checkpoints may take several hours and this can sometimes lead to complications in their 481 condition. When referring to 'western individualistic culture', it presents as if there is a homogenous culture, and while individualistic inclinations may be more common, maybe you could say something like where there is more emphasis on individualistic frames of reference and more concern for individual autonomy in the literature focused on Western societies and culture, studies from the Middle East and East Asian contexts give greater emphasis to the role of the family and to collective decision-making that also influences the communicative practices of a cancer diagnosis. (this is just a suggestion, and obviously alternative wording can be posed that would allow for some of that nuance to come through). [Note: HTML markup is below. Please do not edit.] [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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0252608.r003
Revision 2
10 May 2021 Author Response Dear PLOS ONE Editor and anonymous reviewers, My co-authors and I are grateful for the attention given to our manuscript PONE-D-20-3697R1 and the suggestions offered by the editor. We changed the manuscript accordingly in lines 478-481 and rephrase the reference to western individualistic culture as recommended. Kind regards, The Authors Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0252608.r004
19 May 2021 Decision Letter - Weeam Hammoudeh, Editor Social support for breast cancer patients in the occupied Palestinian territory. PONE-D-20-36979R2 Dear Dr. Alby, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Weeam Hammoudeh Guest Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0252608.r005
Formally Accepted
24 May 2021 Acceptance Letter - Weeam Hammoudeh, Editor PONE-D-20-36979R2 Social support for breast cancer patients in the occupied Palestinian territory. Dear Dr. Alby: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Weeam Hammoudeh Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0252608.r006

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