PONE-D-21-02293

Factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy: A cross-sectional study

PLOS ONE

Dear Dr. YANG,

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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: No

Reviewer #3: Yes

Reviewer #4: Partly

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

Reviewer #1: No

Reviewer #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: 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: No

Reviewer #3: Yes

Reviewer #4: 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: Thank you for the opportunity to review this descriptive analysis investigating the factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy.

After reading this article carefully, some significant issues should be addressed.

1.This study has used several questionnaires or scales as the measurement tool, for example, the questionnaires for general characteristics of participants including care related variables (line 96-100), Knowledge of Emergency Scale (line 101-102), the ADLs (line 118-119) and the Caring Behavior Scale (line 123-128). However, I cannot find the questionnaires themselves and if the questionnaires have been validated after reading some of the references. Although the questionnaires might be published in other journals, the questionnaires might not be suitable for the participants in this study, and the reliability and validity should be mentioned in this article. For example, I am wondering how does the questionnaire ask about the “education for discharge care”. Does the answer “YES” “NO” really mean the true results that the researcher wants to measure? In addition, the rating method of ADLs seems not the same as the reference [22] mentioned.

2.How did the 100 participants been selected? Selection issue should be considered.

3.The results in line 216 to line 22 should be re-written without directly mention the beta and p-value which the reader can see in Table 5.

Reviewer #3: It is an interesting study for caring behaviors of HMV patients. The study is important for surveying caring quality for caring behaviors. There are several minors questions needed to be answered.

Question 1: 91.6% of patients did not have experience of emergency situation in the study. However, the table 5 showed the factor of experience of emergency situation positively associated with caring behavior. How could author explain the result because most of patients seem to be relative stable?

Question 2: The mean age of patients is young (38.08±26.62) for the need of HMV. The authors should state what kinds of neuromuscular and airway disease of patients.

Question 3: In line 194: “Caring behavior of ventilator management was 61.94 (±6.94) out of 50”. It seems 61.94 (±6.94) out of 70 instead of 50.

Reviewer #4: This study aimed to delineate the caring behaviors of family caregivers for patients receiving home mechanical ventilation(HMV) with tracheostomy and to identify factors associated with their caring behaviors in South Korea. This was a cross-sectional study for 95 family caregivers for patients with invasive HMV. The factors associated with care behaviors of the family caregivers were identified by multiple regression analysis, and the variables for final regression model were selected by the backward selection method. The results showed that the caring behavior of caregivers were associated with ADL of patient, knowledge on emergency care, preparedness of equipment for emergency situations, and experience of emergency situations. This indicates that a more organized discharge process is needed, including a standardized discharge program and the utilization of various teaching methods at the hospital. The author concluded that development of standardized multidisciplinary discharge education for improving the caring capacity of caregivers is required for successful and healthy application of home mechanical ventilation.

Major points:

1.The conclusion part in the page 17 is too subjective because there was no result in this study support using the simulation training with specific scenarios. I would suggest only the first sentence to be kept. Please make point-to-point reply to the results by Tables.

2.There is one measure needed to be clarified. In Table 3 (Page 11). Caring Behavior Scores of Family Caregivers regarding Ventilator management: 61.94±6.94 ( min 14 and Max 50). Why?

3.For readers, it would be interesting to understand the current caregiver training programs before discharge. Could the authors explain more about this? That would help why the score regarding rehabilitation and communication are relatively lower than other domains. And from the results, what kind of education or training program needs to be modified? Please explore more on this for implication.

4. Could the authors disclose the 12.7 items of required equipments in Table 2?

minor points:

1.This is a self-reported questionnaire to reflect the caring behavior score. I wonder if the actual caring skills of family caregivers can be measured by home visited nurses or health care workers at home.

2.This could be only applied to the patients with HMV who lived with incentive family caregivers in the big city area, because of the limited number of respondents.

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Reviewer #1: No

Reviewer #3: No

Reviewer #4: No

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Factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy: A cross-sectional study

PONE-D-21-02293R1

Dear Dr. YANG,

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,

Tai-Heng Chen, M.D.

Academic Editor

PLOS ONE

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 #3: All comments have been addressed

Reviewer #4: 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 #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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

Reviewer #3: Yes

Reviewer #4: Yes

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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 #3: Yes

Reviewer #4: Yes

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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: Thank you for the opportunity to review this descriptive analysis investigating the factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy. AND congratulation to your work. The issues I have mentioned have been addressed. Please make sure that all supporting information has been uploaded as the supplementary carefully.

Reviewer #3: (No Response)

Reviewer #4: The authors replied my concerns one by one clearly. It looked sound after revision. I have no more question.

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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 #3: No

Reviewer #4: No