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PONE-D-21-12063The use of 3D digital anatomy model improves the quality of communication with patients presenting with prostate disease, first experience in SenegalPLOS ONE

Dear Dr. Diao,

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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: No

Reviewer #3: Partly

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

Reviewer #1: N/A

Reviewer #2: No

Reviewer #3: 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: Yes

Reviewer #3: 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

Reviewer #3: 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 manuscript is simple but informative. Also the results are expected.

The number of patients and physicians accessed was reasonable.

While any image is better than no image, I would add simple anatomic figures to be more comprehensive to patients.

It is a huge challenge the fact that "76.6% of physicians complained that using the computer model lengthened the consultation."

This might reflect the complexity and inaccuracy of utilized model and interface (computer).

In our practice, simple and didactic anatomic pictures on the physician's office wall play similar role, certainly taking less time.

Reviewer #2: This manuscript presents the use of a 3D digital anatomy model of the prostate to help improve patient-provider communication in Senegal. While the concept is quite interesting, this study lacks depth and clarity. This manuscript could be strengthened with major revisions. Below, are outline comments by sections.

Introduction

• Should identify more current statistics on worldwide rates of prostate cancer deaths.

• It is unclear how “sociocultural realities that render prostate disease a taboo subject” is ameliorated or even considered in the context of this intervention. It is also unclear how this intervention has the potential to impact limited knowledge of prostate disease that are often not seen until presented complicated or as advanced disease. This is not a community intervention on awareness, but rather a clinical intervention after clinical presentation.

• This authors must reconsider what is important to present as relevant background information for this study.

• Given the preliminary and exploratory nature of this study, this should be stated clearly upfront.

Methods:

• Given the discussion of the 3D digital anatomy model section, it is unclear if a standard image was shown to all patients in the study, or if the image was personalized based on the individual patient case. It is unclear why there is a section on a specific patient case of a 62 year old man.

• Under study design, authors indicate “patient first received … standard manual drawings, followed by … 3D digital…” What is the standard manual drawing based on? Is it just what the physician was able to draw themselves or a pre-drawn out image on a paper? More detail is needed for clarity.

• The questions are quite limited in nature and should be addressed in a limitations section.

• What, if any, incentives were provided to study participants – whether patients or providers?

Results

• A comparison/usual care group could be much more informative and insightful, along with more detailed questions to assess quality of communication, understanding, communication skills, etc., even for low literacy groups, with low response burden.

• Authors should be more clear that the questions assess perception/perceived point of view. For example, asking about improved level of understanding as improved or declined, is perceived and not objective as asking actual questions that assess knowledge. This should also be acknowledged in a limitations section.

Discussion

• Authors should rephrase discussion section and conclusions drawn to be more accurate. For example, quality was not assessed and the conclusion that quality of communication improved is not accurate. There was no comparison group to show an improvement, nor a pre/post questionnaire, for example.

• Impact on physicians – There is also extreme over simplification of communication skills. Nothing that was presented in the intervention dealt with communication – e.g., what is actually said/communicated to patients. This 3D image is a visual “tool” that has the potential to enhance communication, but that was not measured in this study, but rather participants’ perspective on usability or utility, and even that is quite limited in the 4 questions asked of patients and providers.

• Statistical significance – It is unclear why there is a section on statistical significance when this study was exploratory in nature and only presented descriptive statistics. This section seems inappropriate.

• The additional subheadings following the discussion section is confusing, when some appear to be appropriate for the methods section.

• Digital software – what is the difference between the two platforms mentioned, besides one being free? Why bring this up as an option?

• The section on longevity of findings also seem inappropriate and inaccurate given the nature of this study.

Reviewer #3: The manuscript represent the result of a survey on the use of a 3D digital anatomy model in urology consultation to reflect its effect on improving the communication of physician and patients. An interesting model used in this study which based on the results of the survey demonstrated an improved communication between physicians and patients. However, I do not believe the survey results are presented and discussed properly. in more detail (e.g. consider results in referral groups and).

1. It is not clear if patients information such as age is collected in the survey. If it has been collected, the results should be reported and investigated in terms of any association with age groups (e.g. elderly patients might gain less benefit from the technology compared to younger patients). Otherwise, it should be mentioned that age of patients are not recorded in survey with a discussion on the reason.

2. There is no statistical method applied to investigate the result of the survey. Authors need to apply statistical methods to add the uncertainty associated with the reported percentage (e.g. in terms of confidence intervals). Also the chi-square or other relevant tests should be applied to investigate the association of each questionary with available patient groups (referral group, age groups, etc).

3. Authors need to report results of the questionaries in the survey by the referral groups and investigate any association between referral groups and each questionary (e.g. different treatment usually are recommended for patients with different group so it would be interesting to consider how patients’ decision has changed regarding their referral group).

4. Impact on patients in discussion, it is mentioned that “A tool that facilitates the communication and understanding of prostate diseases could be beneficial in improving the quality of care and reducing healthcare costs”. However, it is not well discussed how such a tool could reduce healthcare cost, and I suggest authors to add a discussion justifying this. (lines 168-170)

5. They mentioned that the use of such a 3D digital anatomy model is helpful for treatment decision of high-risk patients. It is not clear how the presented results are supporting such a statement! A clear discussion needs to be added including how the patients decisions are improved by use of such a 3D digital anatomy model. (lines 177-182)

6. Some of subsections in the discussion should be moved and presented in the Method section (i.e. Statistical significance, Choice of questionnaires and Choice of digital anatomy viewing software).

7. It is not clear how such a software would be available to be used in the clinical practices if required.

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Reviewer #1: Yes: Leonardo Oliveira Reis

Reviewer #2: No

Reviewer #3: No

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The use of 3D digital anatomy model improves the quality of communication with patients presenting with prostate disease : first experience in Senegal

PONE-D-21-12063R1

Dear Dr. Diao,

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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Yann Benetreau

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Please note reviewer 3's last request, which you may address in your final version.

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 #3: 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 #3: Yes

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

Reviewer #3: 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 #3: (No Response)

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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 #3: (No Response)

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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 #3: In the revised version, the authors substantially improved the presentation of results and discussion. I find the revised version addresses my points, and I only have one minor comment:

While I find Table 3 informative and discussed its results well, I suggest that all chi-square test p-values be reported (regardless of whether they are statistically significant).

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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 #3: No

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