A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy

Syarifah Maisarah Syed Alwi; Mazlina Mazlan; Nur Aishah Mohd Taib; Normah Che Din; Vairavan Narayanan

doi:10.1371/journal.pone.0277056

Peer Review History

Original SubmissionMarch 9, 2022
25 Apr 2022 Decision Letter - Mohamad Syazwan Mohd Sanusi, Editor PONE-D-22-07018Development of a cognitive intervention module for breast cancer survivors with cognitive impairment following chemotherapy: A Delphi studyPLOS ONE Dear Dr. Narayanan 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 Jun 09 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. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: Title: Title is development of module, but the finding form this work only the survey/feedback from the experts. I don’t agree with the title. I strongly agree that this work is “a preliminary work” towards the intervention module. If it is a development of module, the module should be tested or subjected to trials among the CRCI patient. Abstract: Discussion and interpretation of data is limited. No proper intro and statement of problem. Finding and conclusion just highlight about the successful of Delphi technique with limited number of participant and expert (35), somehow not proven in text the effectiveness of this technique like comparison to other approach/ analysis. Introduction, Line 67 – 144: 1) The literature work of related field is limited. The readers would like to know the existence of other work in implementation of CRCI intervention as well as under ACRM and other intervention framework under international commission and societies. Yes, you did mention EF, INSIGHT, PCHP, MAAT, ACTIVE ect., but can you give their findings and stats? This will help reader interpret your problem statements which is why you need to conduct the CRCI intervention using Delphi technique. 2) The author main tool/approach is Delphi technique is not well-discussed 3) In introduction, please provide background of CRCI any stats and figure, if you can give table by states by cases. It will benefit the reader. Material and methods, Line 120: Does this design referring Figure 1? In this section, what is the approach or criteria in selecting the experts. The number 33 of experts passing round 3 could be yield a bias result and need basis or justification in terms of experts selection. Result and discussion: Limited discussion. This part should discuss the development of the intervention module. But author only interpret the figures of survey data from the expect. If not just revise the title accordingly to the contents. [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: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: I Don't Know ****** 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 ****** 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: The authors performed a study addressing “Development of a cognitive intervention module for breast cancer survivors with cognitive impairment following chemotherapy: A Delphi study”. However, there remain several concerns to be clarified, some of which are critical. 1. It is questionable whether this method of statistical analysis can achieve the objectives of the study. Even if trends are known, they may lack credibility. 2. “The Delphi consensus technique is the best available technique to solicit expert opinions on the practicality, feasibility, efficacy, and applicability of the intervention module during the COVID-19 pandemic.” stated in the abstract conclusion, how can we conclude from the present study that it is the best technique? It is of course important to study this in actual patients, but it seems necessary to have a statistical analysis method that can be objectively correct in this study as well. 3. Does this study aim to determine whether the Delphi consensus technique is a technique that can be considered even during the COVID-19 epidemic? We do not believe that this consideration has been adequately addressed. 4. As this study did not examine cognitive impairment in breast cancer patients, this statement may not be necessary. 5. When does the research period begin and end? Reviewer #2: Thank you for your submission. This kind of long term studies are challenging and necessary to advance the field. I appreciate the hard work and effort and a well written article in all aspects. I believe these minor revisions below will make the article much more effective for the readers: Comments 1) In Introduction section, please add a paragraph about association between cancer, chemotherapy and cognitive impairment physiology. 2) Please ad your developed cognitive intervention module as an appendix form. ****** 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: No Reviewer #2: Yes:** Esedulah AKARAS [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. Attachments Attachment Submitted filename: reviewer_comments_PONE-D-22-07018.docx https://doi.org/10.1371/journal.pone.0277056.r001
Revision 1
8 Jun 2022 Author Response EDITOR 1. Title: Title is development of module, but the finding form this work only the survey/feedback from the experts. I don’t agree with the title. I strongly agree that this work is “a preliminary work” towards the intervention module. If it is a development of module, the module should be tested or subjected to trials among the CRCI patient. *Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. The new title is on the first page of the manuscript and it is highlighted in PINK. 2. Abstract: Discussion and interpretation of data is limited. No proper intro and statement of problem. Finding and conclusion just highlight about the successful of Delphi technique with limited number of participant and expert (35), somehow not proven in text the effectiveness of this technique like comparison to other approach/ analysis apparently employed. As such, concerns about inappropriate normative references remain, and continue to threaten the meaningfulness and validity of your findings. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to Abstract, then objectives and changes are highlighted in GREEN. Also, all authors agree with your expert opinion and therefore, we critically evaluate the advantages and disadvantages of the Delphi method and made comparison with other group methods such as a focus group. Kindy go to the Critical reflection on the study and the study results and changes are highlighted in YELLOW. 3. Introduction, Line 67-144: The literature work of related field is limited. The readers would like to know the existence of other work in implementation of CRCI intervention as well as under ACRM and other intervention framework under international commission and societies. Yes, you did mention EF, INSIGHT, PCHP, MAAT, ACTIVE ect., but can you give their findings and stats? This will help reader interpret your problem statements which is why you need to conduct the CRCI intervention using Delphi technique. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Previously published systematic review of cognitive intervention that evaluated the effects of cognitive rehabilitation programs on cognitive impairment among the various population of participants with non-central nervous system (CNS) cancer patients have produced inconsistent findings (Fernandes, Richard, & Edelstein, 2019; Treanor et al., 2016). For example, Treanor and colleagues (2016) did not make equivocal recommendations on the effectiveness of non-pharmacological interventions in ameliorating cognitive function following chemotherapy treatment for mixed cancer patients. This systematic review used the cognitive intervention recommended by the Cognitive Rehabilitation Task Force of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) similar to our present study but among mixed cancer patients. In 2021 (Syed Alwi et al., 2021), we published a systematic review that used the cognitive intervention recommended by the Cognitive Rehabilitation Task Force of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) among breast cancer survivors. At present, there are only 10 studies conducted investigated the effectiveness of cognitive intervention for breast cancer survivors. The published studies reported the effect size (Cohen’s d). Therefore, all authors agree to use the effect size in reporting the effectiveness of the cognitive intervention. Kindly go to the Introduction and changes are highlighted in YELLOW. The author main tool/approach is Delphi technique is not well-discussed. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Introduction and changes are highlighted in PINK. In introduction, please provide background of CRCI any stats and figure, if you can give table by states by cases. It will benefit the reader. Accepted and made changes. All authors agree with your suggestion. We understand that the table will benefit the reader. However, all authors made the decision not to include the table because it is not our primary objective of our present study. Therefore, we provide the ranges for both prevalence and incidence of cognitive impairment. To the best of our knowledge there are a lot of published studies that are available examining the prevalence and incidence of cognitive impairment with the earliest study conducted in 1998. Many of newer studies in this field has been cited in the Introduction. Kindly go to the Introduction and changes are highlighted in GREEN. We have added the prevalence and incidence of cognitive impairment. 4. Material and methods, Line 120: Does this design referring Figure 1? In this section, what is the approach or criteria in selecting the experts. The number 33 of experts passing round 3 could be yield a bias result and need basis or justification in terms of experts selection. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Material and methods and Study designs and changes are highlighted in PINK. Kindly go to the Material and methods and Participants and approach or criteria in selecting the experts are highlighted in TURQUOISE. In principle, the validity of the results obtained from the Delphi method does not root in the statistical significance but rather in the iterative process of expert opinion development and consensus building (Cole et al., 2013). Therefore, we highlighted the issue of statistical significance in the Introduction (highlighted in PINK) and critically evaluated the advantages and disadvantages of the Delphi method and made a comparison with other group methods such as a focus group. Kindy go to the Critical reflection on the study, and the study results and changes are highlighted in YELLOW. 5. Result and discussion: Limited discussion. This part should discuss the development of the intervention module. But author only interpret the figures of survey data from the expect. If not just revise the title accordingly to the contents. Accepted and made changes. All authors agree with your suggestion. We revised the title of our manuscript. REVIEWER 1 1. It is questionable whether this method of statistical analysis can achieve the objectives of the study. Even if trends are known, they may lack credibility. Thank you very much for your expert opinion. Accepted and made changes. All authors agree with your expert opinion. In principle, the validity of the results obtained from the Delphi method does not root in the statistical significance but rather in the iterative process of expert opinion development and consensus building (Cole et al., 2013). Therefore, we highlighted the issue of statistical significance in the Introduction (highlighted in PINK) and critically evaluated the advantages and disadvantages of the Delphi method and made a comparison with other group methods such as a focus group. Kindy go to the Critical reflection on the study, and the study results and changes are highlighted in YELLOW. 2. “The Delphi consensus technique is the best available technique to solicit expert opinions on the practicality, feasibility, efficacy, and applicability of the intervention module during the COVID-19 pandemic.” stated in the abstract conclusion, how can we conclude from the present study that it is the best technique? It is of course important to study this in actual patients, but it seems necessary to have a statistical analysis method that can be objectively correct in this study as well. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. In line with the Editor’s suggestion, we understand that we used a strong term to claim that the Delphi method is the best technique that may create issues or misunderstandings in our work. Therefore, all authors decided to remove the term “best technique during the COVID-19 pandemic” from the text. 3. Does this study aim to determine whether the Delphi consensus technique is a technique that can be considered even during the COVID-19 epidemic? We do not believe that this consideration has been adequately addressed. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. We understand that we used a strong term to claim that the Delphi method is the best technique that may create issues or misunderstandings in our work. Therefore, all authors made the decision to remove the term “best technique during the COVID-19 pandemic” from the text. 4. As this study did not examine cognitive impairment in breast cancer patients, this statement may not be necessary. Thank you very much for your suggestion. Unable to make any changes All authors would like to apologize for not being able to make any changes to this suggestion because we are unable to find this point in our text. Patient with cognitive impairment in breast cancer is the main population being studied here. As such CRCI appears in many places in this present study. 5. When does the research period begin and end? Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Material and methods, and Study designs and changes are highlighted in GREEN. REVIEWER 2 1. In Introduction section, please add a paragraph about association between cancer, chemotherapy and cognitive impairment physiology. Thank you for your suggestion. Accepted and made changes. All authors agree with the suggestion. Kindly go to the Introduction and changes made are highlighted in TURQUOISE. 2. Please add your developed cognitive intervention module as an appendix form. Thank you for your suggestion. All authors understand the importance of the cognitive intervention module. We could not disclosed the developed intervention in this present study because of the following reasons: 1) We are in the process of testing the intervention among our breast cancer survivors. 2) We would like to obtain the copyright of the intervention if the intervention improved the cognitive impairment of our breast cancer survivors. However, all authors agree to make sure that the cognitive intervention module will be available upon request. Attachments Attachment Submitted filename: EDITOR.docx* https://doi.org/10.1371/journal.pone.0277056.r002
11 Jul 2022 Decision Letter - Mohamad Syazwan Mohd Sanusi, Editor PONE-D-22-07018R1A Delphi technique to consensus building of a cognitive intervention module for breast cancer survivors with cognitive impairment following chemotherapyPLOS ONE Dear Dr. Narayanan, 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 August 25, 2022. 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, Mohamad Syazwan Mohd Sanusi Academic Editor PLOS ONE ********** [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. Attachments Attachment Submitted filename: 10 July EDITORs comments.docx https://doi.org/10.1371/journal.pone.0277056.r003
Revision 2
27 Aug 2022 Author Response 1. A Delphi technique to consensus building of a cognitive intervention module for breast cancer survivors with cognitive impairment following chemotherapy. The title above still reflecting on the author’s work one a developed module. As commented previously, it should never be a module development. A survey technique (Delphi) to consensus building is relevant only for a preliminary work to develop an intervention framework or to validate after the module have been developed. My title suggestion: A Delphi technique toward a development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy. *Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. The new title is on the first page of the manuscript and it is highlighted in PINK. 2. Results and conclusion have not been highlighted in abstract. None has been addressed. It is important to highlight the main finding from this study. Otherwise it will be an ambiguous work. Eg. What criteria are all agreed by experts? Experts agreed on attention and memory training objectives? On suitability of the language and clarity of the instructions? Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to Abstract, then Results and Conclusion, and changes are highlighted in YELLOW and TURQUOISE. Critical reflection on the study and the study results: Acceptable Thank you very much for the expert opinions given earlier to improve the manuscript. 3. Please include the comments given here in the manuscript text body. Then copy and paste put it in your introduction, so reader know the background of the study. Indicate the details of results and citation of your previous work. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Introduction and changes are highlighted in TURQUOISE. Please address the details of those 10 studies in summary or table. It would be preferable in Table. Line 79-83. Thank you very much for your suggestion. Accepted but unable to make changes. We would like to apologize for not being able to include the table requested because all authors believed that it can be considered self-plagiarism. Therefore, we provided the citation of our systematic review and summarized the studies in the current text. Please extend the discussion by giving few examples of cognitive impairment. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Introduction and changes are highlighted in YELLOW. 4. Line 264-280: Redundant. Not significant to be discussed in this part. These have been mentioned in introduction/problem statement. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Discussion. The points in lines 264 to 280 were removed. 5. Discussion - Sufficient Thank you very much for the expert opinions given earlier to improve the Discussion. 6. Conclusion – Line 383-384 -: Justification on this multiracial/mutiecthnic. Can it be applied to other southeast asia region? Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Conclusion and changes are highlighted in TURQUOISE. Line 384: This module? This work is preliminary work not accredited or etsbalished module. Please change “the module” with “the proposed framework” or “the module elements”. Please revise throughout the study from this comment. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. We have revised our manuscript accordingly. Changes can be seen throughout the text with “framework module” or “proposed framework” highlighted in GREEN. In this section, please provide one MAIN conclusion. Practicable? Sensible/relevant? *Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to the Conclusion and changes are highlighted in YELLOW. Attachments Attachment Submitted filename: EDITOR.docx* https://doi.org/10.1371/journal.pone.0277056.r004
26 Sep 2022 Decision Letter - Mohamad Syazwan Mohd Sanusi, Editor PONE-D-22-07018R2A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapyPLOS ONE Dear Dr. Narayanan, 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 21 October 2022. 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, Mohamad Syazwan Mohd Sanusi Academic Editor PLOS ONE Additional Editor Comments (if provided): Dear author, please submitted the correct document of the corrected manuscripts. The document entitled "EDITOR.docx" are given details of author response/actions toward the reviewer comment, however the document entitled "MAIN TEXT FILE WITH TRACK CHANGES" only contains some of the corrected text. It is difficult to follow some of the author response eg; (All authors agree with your suggestion. Kindly go to the Introduction and changes are highlighted in PINK), but nothing is highlighted in PINK colour. So please check it ASAP [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.0277056.r005
Revision 3
30 Sep 2022 Author Response 1. The document entitled "EDITOR.docx" are given details of author response/actions toward the reviewer comment, however the document entitled "MAIN TEXT FILE WITH TRACK CHANGES" only contains some of the corrected text. It is difficult to follow some of the author response eg; (All authors agree with your suggestion. Kindly go to the Introduction and changes are highlighted in PINK), but nothing is highlighted in PINK colour. So please check it ASAP. ******** Dear Editor, We would like to apologise for the inconvenience that we have caused. Also, to accelerate the process, we added PAGE NUMBER under ACTION(S). 2. A Delphi technique to consensus building of a cognitive intervention module for breast cancer survivors with cognitive impairment following chemotherapy. The title above still reflecting on the author’s work one a developed module. As commented previously, it should never be a module development. A survey technique (Delphi) to consensus building is relevant only for a preliminary work to develop an intervention framework or to validate after the module have been developed. My title suggestion: A Delphi technique toward a development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy. ****** Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. The new title is on PAGE 1 of the manuscript and it is highlighted in PINK. 3. Results and conclusion have not been highlighted in abstract. None has been addressed. It is important to highlight the main finding from this study. Otherwise it will be an ambiguous work. Eg. What criteria are all agreed by experts? Experts agreed on attention and memory training objectives? On suitability of the language and clarity of the instructions? Critical reflection on the study and the study results: Acceptable ****** Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 2, Abstract, then Results highlighted in YELLOW and Conclusion highlighted in TURQUOISE. Thank you very much for the expert opinions given earlier to improve the manuscript. 4. Please include the comments given here in the manuscript text body. Then copy and paste put it in your introduction, so reader know the background of the study. Indicate the details of results and citation of your previous work. Please address the details of those 10 studies in summary or table. It would be preferable in Table. Line 79-83. Please extend the discussion by giving few examples of cognitive impairment. ****** Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 4 and PAGE 5, then the Introduction and changes are highlighted in TURQUOISE. Accepted but unable to make changes. We would like to apologize for not being able to include the table requested because all authors believed that it can be considered self-plagiarism. Therefore, we provided the citation of our systematic review and summarized the studies in the current text. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 4, the Introduction and changes are highlighted in YELLOW. 5. Line 264-280: Redundant. Not significant to be discussed in this part. These have been mentioned in introduction/problem statement. ****** Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 10, the Discussion. The points in lines 264 to 280 were removed. 6. Discussion - Sufficient Conclusion – Line 383-384 -: Justification on this multiracial/mutiecthnic. Can it be applied to other southeast asia region? Line 384: This module? This work is preliminary work not accredited or etsbalished module. Please change “the module” with “the proposed framework” or “the module elements”. Please revise throughout the study from this comment. In this section, please provide one MAIN conclusion. Practicable? Sensible/relevant? ******** Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 13, to the Conclusion and changes are highlighted in TURQUOISE. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. We have revised our manuscript accordingly. Changes can be seen throughout the text with “framework module” or “proposed framework” highlighted in GREEN. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 13 the Conclusion and changes are highlighted in YELLOW. Attachments Attachment Submitted filename: EDITOR DR MOHAMAD SYAZWAN.docx https://doi.org/10.1371/journal.pone.0277056.r006
17 Oct 2022 Decision Letter - Mohamad Syazwan Mohd Sanusi, Editor PONE-D-22-07018R3A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapyPLOS ONE Dear Dr. Narayanan, 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 19 October 2022 (3 DAYS) . 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, Mohamad Syazwan Mohd Sanusi 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): Well done for the revised manuscript. We found all the reviewer comments/recommendations have been successfully addressed by the authors. The submitted can be considered accepted for publications with minor correction need to be done. Please find my commnets below for your perusals. Abstract, Line 61-65 - Please revise the conclusion in the abstract. The current conclusion in abstract should be in ONE LINE, which addressing the final conclusion of your work. In my humble evaulation, the first line (61-63) just explaining what your work is aiming at, objective etc. and the second line is recommendations. My suggestion/example: This study found out that a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfuly developed/ or feasible to be impleted using Delphi technique/study/approach. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [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.0277056.r007
Revision 4
17 Oct 2022 Author Response Abstract, Line 61-65 - Please revise the conclusion in the abstract. The current conclusion in abstract should be in ONE LINE, which addressing the final conclusion of your work. In my humble evaluation, the first line (61-63) just explaining what your work is aiming at, objective etc. and the second line is recommendations. My suggestion/example: This study found out that a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfully developed/ or feasible to be implemented using Delphi technique/study/approach. ******* Dear Editor, We would like to express our gratitude for reviewing our manuscript. Thank you very much for your suggestion. Accepted and made changes. All authors agree with your suggestion. Kindly go to PAGE 2 (LINE 61-63), Abstract, then Conclusions and changes are highlighted in GREEN. Attachments Attachment Submitted filename: EDITOR DR MOHAMAD SYAZWAN.docx https://doi.org/10.1371/journal.pone.0277056.r008
19 Oct 2022 Decision Letter - Mohamad Syazwan Mohd Sanusi, Editor A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy PONE-D-22-07018R4 Dear Dr. Narayanan, 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, Mohamad Syazwan Mohd Sanusi Academic Editor PLOS ONE Additional Editor Comments (optional): Congrats Mrs. Syarifah and Prof. Narayanan et al. for the hardwork. Reviewers' comments: https://doi.org/10.1371/journal.pone.0277056.r009
Formally Accepted
24 Oct 2022 Acceptance Letter - Mohamad Syazwan Mohd Sanusi, Editor PONE-D-22-07018R4 A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy Dear Dr. Narayanan: 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. Mohamad Syazwan Mohd Sanusi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0277056.r010

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