PONE-D-20-36374

Awareness of diagnosis, treatment plan and prognosis among patients attending public hospitals and health centers in Addis Ababa, Ethiopia.

PLOS ONE

Dear Dr. Teklu,

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Kingston Rajiah

Academic Editor

PLOS ONE

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[This study was funded by MERQ PLC.]. 

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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: Yes

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: 1. An overall comment is for the quality of writing: English language is sometimes not the most appropriate. I urge authors to check the text thoroughly before resubmission and to read other published papers from the journal to check the style of writing.

2. The author must add the inclusion and exclusion criteria in the study.

3. The research work Awareness of diagnosis, treatment plan and prognosis among patients attending public hospitals and health centers in Addis Ababa, Ethiopia is well conducted among the patients, the sample size is to be increased, and further work may be carried out.

4. The authors also add the limitations of the study.

Reviewer #2: General comment: this study examines an important question about patients perception and understanding of care received. Inconsistencies in data and need of further clarity on methodology need to be examined.

Specifics:

Abstract: “Patients with good experience at their clinical assessment had significantly lower awareness of their prognosis"

Conclusion: “Patients with good experience at their clinical assessment had significantly higher awareness of their prognosis.”

--> both statements are in contradiction, also "(OR=0.25; 95% CI: 0.08, 0.81)” in the abstract does not correspond to the data in the table

Did the authors collect data on gender of health care providers? Was there a difference in patient knowledge of diagnosis, treatment plan or prognosis depending on provider gender? If provider gender was not examined would perhaps rephrase: “Patient care is shifting globally towards patient-centered approach [1, 2].”

“Questionnaire (PEQ) (25), Patient Perception of Patient-Centeredness (PPPC) scale (26), Perception on Quality of Health Service, General Patient Satisfaction Scale (27) and Items on Patients Awareness on their Diagnosis, treatment and Prognosis (28).”

was this translated or did the interviewer use the English version and each translate themselves? Were these instruments validated in the translated language? What language was used? Please provide a copy of the English and translated version as an appendix. Some validation of the instruments would be useful for this and future publications. This will also help readers to better understand how variables such as "patient centeredness" or "prognosis" or the variarious satisfaction/good care variables were defined.

Also authors could provide a reference indicating that documenting prognosis separate from the diagnosis and treatment plan is a requirement in medical notes. Is this now a requirement in Ethiopia, WHO, etc for example? Often prognosis is implicit in the diagnosis and treatment plan in medical notes.

“We used logistic regression models to assess factors associated with awareness of diagnosis, treatment plan and prognosis”

What variables were included in these models? Has were interactions assessed and managed? It is not clear in the results section which results were bivariate, which were from multivariate models and or variables were included in the models.

Gynecologic patients had significantly lower awareness about their diagnosis and treatment plan, compared to who? Why is this different from females in general?

How could patients understand prognosis if they don’t know the diagnosis or treatment plan?

Also in the introduction would indicate the location of the references like in the discussion.

% in the text of the result would be better in a table.

Data from the tables to keep tract

Awareness of Diagnosis Awareness of Treatment Awareness of Prognosis

Female

179(63.3) 163(54.2) 244(72)

1.40(0.91,2.15) 0.129 1.20(0.8,1.81) 0.374 1.17(0.73,1.86)0.511

Gynecology

31(48.4) 29(43.9) 64(77.1)

0.29(0.12,0.73) 0.009 0.30(0.12,0.77) 0.013 0.92(0.34,2.52) 0.879

General satisfaction (Ref: Not satisfied)

131(58.5) 116(48.5) 166(61.5)

0.68(0.43,1.05) 0.082 0.75(0.49,1.14) 0.179 0.75(0.47,1.19) 0.222

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Reviewer #1: No

Reviewer #2: No

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PONE-D-20-36374R1Awareness of diagnosis, treatment plan and prognosis among patients attending public hospitals and health centers in Addis Ababa, Ethiopia.PLOS ONE

Dear Dr. Teklu,

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.

Dear Author,  This could be an important descriptive study. Kindly upload the questionnaire used. Prognosis assessment is important. The range of diagnosis is different from references cited. This is why this study may be important, but the authors should provide a detailed description of what they mean. Finally, statistics need to be addressed or regression model(s) removed and only publish bivariate analysis as a descriptive study. 

Also, address the comments by the reviewer. Please submit your revised manuscript by Jan 27 2022 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: https://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,

Kingston Rajiah

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.

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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: (No Response)

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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: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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: No

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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 #2: No

**********

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: The authors have addressed all the queries raised by the reviewers and the article maybe accepted for publication.

Reviewer #2: Thank you to the authors for addressing issues

However, further clarifications would help

1-Decription of prognosis assessment in the African setting is important. More information how this was done would be helpful. For example, in the method section specifically described what questions were used and how was prognosis knowledge defined. Specifically, was it based on threat to life in short or long term, or possibility of disease chronicity? How were diagnosis in Ethiopian same or different to conditions in the reference's articles: cancer, schizophrenia in Western medicine setting? Explicit description of who with what diagnosis met prognosis understanding criteria would help.

2-The multiple regression analysis could use further clarity and description in the method section and table 3 (the title does not state that this is a multiple regression. Also it is not clear what are separate models, what are controlling variables, also interactions assessment is not addressed, the issue of multiple analysis alpha level adjustment mentioned by the editor also needs attention).

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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 #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/. 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.

Awareness of diagnosis, treatment plan and prognosis among patients attending public hospitals and health centers in Addis Ababa, Ethiopia.

PONE-D-20-36374R2

Dear Dr. Teklu,

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,

Kingston Rajiah

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: