PONE-D-21-08049

Health care utilization at end of life among patients with lung or pancreatic cancer. Comparison between two Swedish cohorts

PLOS ONE

Dear Dr. Ullgren,

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:

Specifically:

1-For readers who are not familiar with the Swedish health care system, please elaborate on the quality and accessibility of the study population to the specialized palliative care (SPC)  as in/out- patient. What would SPC at the home cover, which is different from in-patient palliative care services and resulting in decreased numbers of acute hospital beds?

2- Please be specific on the integration of EOL care and how the increased use of SACT, ED visits, ICU care, and death in other care settings endanger this integration?

3- Please address comments by reviewers #1,2

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Amir Radfar, MD,MPH,MSc,DHSc

Academic Editor

PLOS ONE

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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: 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: The study emphasizes the importance of integrating a palliative care approach, including conversations about care goals and preferred place of death. In addition, better psychosocial support and care coordination are important factors in avoiding acute care at EOL. Another interesting change was the fact that a higher percentage of patients died in non-acute settings. In terms of the organization of EOL care, the results show an increase in the use of SPC at home over time. Despite this, our findings raise questions about how well-integrated care is, as the use of SACTs, ED visits, ICU care and death in other care settings has increased. the study found that communication between acute and palliative health organizations is inadequate and has an impact on unplanned acute hospital admissions.

Research which I hope will be a stimulus for health care organizations and stakeholders to better organize and coordinate care for vulnerable patients

Reviewer #2: An extremely clear and well written report.

I do wonder about the availability of data regarding provision of care and potential differences between 2010 and 2017: E.g. in the discussion section, page 11 starting in line 244: could authors comment regarding provision of care, mainly a) healthcare professionals palliative care training differences between 2010 and 2017 and b) the existing number of home care teams between 2010 and 2017 across the region and if these could have affected results in any way

There are quite a few typos. This is by no means an exhaustive list.

Page 3 line 53 “and to be to able prepare and discuss the purpose and priorities at EOL”

Page 3 line 57 “but a set of measures is widely used”

Page 4 line 86 “Diagnostic data were retrieved”

Page 4 line 92 “patients with lung or pancreatic cancer who died in Stockholm”

And so on

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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: Cascioli Marta

Reviewer #2: No

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Health care utilization at end of life among patients with lung or pancreatic cancer. Comparison between two Swedish cohorts

PONE-D-21-08049R1

Dear Dr. Ullgren,

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,

Amir Radfar, MD,MPH,MSc,DHSc

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: 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

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: I find the article interesting and above all I hope it is a stimulus to improve the implementation of palliative care networks and increase communication between the hospital and the local area.

Unfortunately, there is still a large gap both for cancer patients (as demonstrated by the study) and for non-cancer patients

Reviewer #2: All points by the editors and reviewers were addressed. The paper is improved. I have no further comments.

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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: Yes: Cascioli Marta

Reviewer #2: No