PONE-D-21-11640‚It felt like a black hole, great uncertainty, but we have to take care for our patients’ – Qualitative findings on the effects of the COVID-19 pandemic on specialist palliative home carePLOS ONE

Dear Dr. Jansky,

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.

This is an important article that is likely to have relevance internationally. Two reviews have been completed, please respond to the comments from the reviewers. For reviewer 2, who suggest the dates of the focus groups should be in the methods, I will be guided by the authors as to their preference here as it is my feeling it is common to have this in results, as you have done. However, I would also request that: 1) the authors perform a very detailed proof read, use consistent language for COVID-19 and identify and remove any errors in the paper identified by reviewers;2) PallPan is given context throughout, this is in the abstract but the relevance to the study is not clear. Is it needed in the abstract? Please ensure it is defined and clear for an audience not familiar with this project,3) For the results, would the authors consider using subheaders? There are not many quotes presented, please consider whether the findings are adequately supported with data.4) I found figure 1 to be confusing and hard to read. Please either provide a clearer version and clarify how it contributes to interpretation of the findings, or remove. 

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Anna Ugalde, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Thank you for this submission to Plos One. This is an important article that is likely to have relevance internationally. Two reviews have been completed, please respond to the comments from the reviewers. For reviewer 2, who suggest the dates of the focus groups should be in the methods, I will be guided by the authors as to their preference here as it is my feeling it is common to have this in results as they have done. However, I would also request that: 1) the authors perform a very detailed proof read, use consistent language for COVID-19 and identify and remove any errors in the paper identified by reviewers; 2) PallPan is given context throughout, this is in the abstract but the relevance to the study is not clear. Is it needed in the abstract? Please ensure it is defined and clear for an audience not familiar with this project, 3) For the results, would the authors consider using subheaders? There are not many quotes presented, please consider whether the findings are adequately supported with data. 4) I found figure 1 to be confusing and hard to read. Please either provide a clearer version and clarify how it contributes to interpretation of the findings, or remove.

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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: Partly

Reviewer #2: Partly

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

Reviewer #1: No

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for the opportunity to review your manuscript. I am sure that the experiences of German specialist palliative home care teams mirrored the experiences of most home-based palliative care teams during the first and subsequent waves of the COVID-19 pandemic.

General comments:

-Either consistently refering to the virus as COVID-19 or SARS-CoV-2 throughout rather than using the terms interchangeably. My recommendation would be to stick with COVID_19 as it is in common usage and recognisable to all sectors of the community.

- Careful editing will eliminate the syntax and grammar errors throughout- there are some challenges to both meaning and fluency but they are minimal.

-Review use of possessive punctuation, for example, it's.

-Review use of brackets and abbreviations- they interfere with fluency. Review use of contractions - for example L238.

- Review sentence structure of some of your longer sentences - some would benefit simply from use of semi-colons or divided into shorter sentences - for example L165-169.

- Urgently review use of "quotation marks" it is unclear if you are indicating verbatim quotations from references or direct quotes from the focus group participants or stakeholder interviews.

-L118-125 reads rather like resumes and does not belong in the body of the manuscript.

Tables and figures:

Table 1: suggest you simplify and remove the focus group composition column and either discuss the composition or include another table. The link to the website you referred to below the table takes you to a blank page with a heading but nothing else.

Figure 1: does not support the inter-connections you discussed in your manuscript- consider re-imagining it to make these connections reflect what you claimed in your results. You might also consider use of an infographic to improve the visual impact of the diagram.

Method: L 70 what do you mean by consent?

You claim to have used qualitative content analysis Philipp (2010- note there is a 2015 version available) but little detail of the process is offered.

Results: are reported with little original (or translated) text offered - this makes it challenging to discern if the interpretations you made were supported by the data you collected. It would strengthen your analysis considerably to support it with quotes from at least a couple of different participants/stakeholders otherwise it is more of a summary than a qualitative analysis.

Consider more clearly outlining the recommendations for future practice as these will be of interest to providers.

Reviewer #2: I read this paper with interest and thank the authors for sharing their work in this important area. I offer the following comments as feedback to help improve its potential contribution to the field/lliterature:

* Please review and correct punctuation used in the title - it appears that a comma is used at the beginning rather than an opening quotation/speech mark (this should correspond with the quotation/speech mark that is correctly used at the end of the quotation).

* Abstract - it seems inconsistent that there is no heading for the first (background/introduction) part of the abstract, but then there are headings for Aim/Method/Results/Discussion. Suggest adding a heading for the first section for consistency.

* use of COREQ reporting guidelines/checklist - I could not see any mention of COREQ checklist Item 28 - whether the study participants provided feedback on the findings? If not, were they offered a reasonable opportunity to do so? Please address this as per COREQ.

* Results - Is "Between September 15, 2020 and September 29, 2020, four focus groups with 4-5 participants were conducted" really a result of the study? I would suggest that the conduct of these FGs is more accurately a research method of data collection. As such, I think this sentence should be relocated to the appropriate ,methods/data collection section - rather than being reported here as a 'result' of the study.

* Limitations - Reference #21 - cited in support of using online FGs: I note this supporting reference comes from the 'Journal of Advertising' wonder why this is considered appropriate? I suggest that you could find a much more relevant source to cite here in this (health research) context. For example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550163/

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Reviewer #1: Yes: Katrina Recoche

Reviewer #2: No

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'It felt like a black hole, great uncertainty, but we have to take care for our patients’ – Qualitative findings on the effects of the COVID-19 pandemic on specialist palliative home care

PONE-D-21-11640R1

Dear Dr. Jansky,

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,

Anna Ugalde, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: