Educational innovation as a communication strategy in palliative care: A study protocol and preliminary results

Ana Paula Salas Moreira; Beatriz Gómez Baceiredo; Carlos Centeno; Carla Reigada

doi:10.1371/journal.pone.0286343

Peer Review History

Original SubmissionDecember 16, 2022
22 Feb 2023 Decision Letter - Samane Shirahmadi, Editor PONE-D-22-33602Educational innovation as a communication strategy in Palliative CarePLOS ONE Dear Dr. Salas Moreira, 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 Apr 08 2023 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, Samane Shirahmadi, PhD Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. During your revisions, please note that a simple title correction is required: Study protocol requires the word ""protocol' to be included in the title. Please ensure this is updated in the manuscript file and the online submission information. 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 4. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. 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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: Our Initial Quality Check of your submission has now taken place. As a result, we need you to address the following points before your manuscript can progress any further: 1. The trial must be registered prior to submission of your protocol in one of the publicly accessible registries approved by the WHO or ICMJE (International Committee of Medical Journal Editors). 2. The name of the registry and the trial or study registration number must be included in the Abstract. 3. A copy of the protocol that was approved by the ethics committee must be submitted as a supplementary information file. Please provide an additional English translation if the original document is not in English. Please note that the protocol will be published with the manuscript if accepted. 4. A SPIRIT schedule of enrollment, interventions, and assessments must be included as the manuscript’s Figure 1, and a completed SPIRIT checklist must be uploaded as Supporting Information file S1. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 ****** 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: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear researcher, Your effort and motivation in doing this research is commendable. Please pay attention to the following points and correct them. 1- In part 3.3, why did you consider the evaluation time 5 months after the first stage? Is there a specific reference or reason? 2- In the first stage of the evaluation, what ways did you use to reduce the error in selecting the participants? For example, did you examine participants' previous knowledge or exposure to palliative care? How? Did you exclude such people from the research? If so, please mention it. 3- In part 4.2, or the focus group, did you assess the previous knowledge of 2 guests about palliative care? Because at the end of the article, you have evaluated their learning about palliative care and you have stated one of the most important results of your research on the basis that: "Our participants' knowledge about palliative care has increased and their skills in transferring This knowledge to others (guests), has been acceptable. 5- In section 4.3, although in the abstract of the article, you stated the method of data analysis of focus groups, it would be better if you mentioned this first in this part of the article. With respect Reviewer #2: Abstract - Methods: determine of date and place of study. -Findings are ambiguous and not explained. Introduction - In the introduction, the importance of the study and the existing gap should be explained The discussion needs more analysis and interpretation ****** 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: Yes: Farshid Shamsaei; Professor of nursing ******** [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: comment.docx https://doi.org/10.1371/journal.pone.0286343.r001
Revision 1
16 Mar 2023 Author Response Dear Reviewers and Editors of PLOS ONE: Allow me to start by extending my sincerest gratitude to the editors who have invested time and effort in finding reviewers for this paper, as well as to the reviewers who have agreed to take upon such request. It carries a lot of weight for us to know that the research we do ignites interest beyond the communication field. Thus, it is with great pleasure that we resubmit our article for further consideration. I would also like to thank all of you beforehand for all the feedback and suggestions. You have raised important questions and I will proceed to enumerate the answers in the following letter. Reviewer #1: Dear researcher, Your effort and motivation in doing this research is commendable. Please pay attention to the following points and correct them. 1- In part 3.3, why did you consider the evaluation time 5 months after the first stage? Is there a specific reference or reason? We have supplemented the section 3.4.4 with explanations as to why a 5-month time frame was selected (page 17, paragraph 2). >>>The 5-month timeframe was selected taking into consideration that the course grades will be made public in early June. Hence, we will be recontacting students no sooner than in November of 2022. Thus, by the time we recontact the students, some of them will be finishing their second-to-last semester in university. This is significant for two reasons. First and foremost, the recontact form they received in the Moment 1 of evaluation allowed communication via their university email. If we wait longer, some of the emails may become inoperative. Secondly, sending invitations with a semester's leeway allows us to have plenty of time to schedule interviews knowing that the students are still in the same geographic location, facilitating face-to-face interviews or at least with similar schedules to ours. 2- In the first stage of the evaluation, what ways did you use to reduce the error in selecting the participants? For example, did you examine participants' previous knowledge or exposure to palliative care? How? Did you exclude such people from the research? If so, please mention it. We have redrafted and added further information on the section 3.4.1 (page 14, paragraph 2) to establish a clearer focus. >>>The initial PCKQ is meant to examine participants previous knowledge on palliative care. If any student shows a formidable knowledge on the topic, they will not be excluded from the study. Their performance will simply be recorded, and any improvement will be taken into consideration. 3- In part 4.2, or the focus group, did you assess the previous knowledge of 2 guests about palliative care? Because at the end of the article, you have evaluated their learning about palliative care and you have stated one of the most important results of your research on the basis that: "Our participants' knowledge about palliative care has increased and their skills in transferring This knowledge to others (guests), has been acceptable. Regarding the section 4.2 on the Message Transmission Experiment, we have elaborated on the assessment of the previous knowledge (page 23, paragraph 2) and we also acknowledge in section 7 that a better assessment of previous knowledge of recipients needs to be done in future interventions (page 30, paragraph 2). >>>1) During the last class of the course, five students were selected to read out loud their speech in front of their classmates and two guests. The guests were two first-year students not enrolled in the course, who have previously display little or no knowledge regarding palliative care in an assignment delivered for another university course. After hearing all the speeches, they were asked to define palliative care. >>>2) After completing the course, some of the students appeared to be able to explain what palliative care is to guest students with little or no experience in the topic. Nonetheless, in future evaluations more work needs to be done in assessing the efficiency of the message transmission. A more accurate assessment of the recipients’ previous knowledge on the topic needs to be carried out. Regarding the section 4.3 on the Focus Group, we have not done any previous knowledge assessment as our sense is that this activity did not aim to evaluate knowledge of any sort. We have added a clarification of our scope and give further information in section 3.4.3 (page 13, paragraph 2). >>>The purpose of this focus group is not to evaluate the knowledge of the participants, but to discuss the strengths and weaknesses of the methodology, the content and other aspects of the course. 5- In section 4.3, although in the abstract of the article, you stated the method of data analysis of focus groups, it would be better if you mentioned this first in this part of the article. We agree with your assessment, and we have reflected this comment by adding the information in section 3.4.3 (page 16, paragraph 3). >>>The focus groups will later be transcribed, and thematic content analysis of the material will be carried out. We have also incorporated your comments regarding the results by redrafting parts of the section 4.1 Palliative Care Knowledge Questionnaire (page 20) and section 7 Conclusions (page 30). Reviewer #2: -Methods: determine of date and place of study. We agree with you and have incorporated this suggestion in section 3 (page 11, paragraph 2). >>>The project started on November 2021 and will continue until September 2024 in Spain. The pilot study took place on the second semester of the academic course 2021-2022, starting on January 2022 (Fig 2). However, enrollment to the course took place five months before, in August of 2022, when the university course registration period was open. -Findings are ambiguous and not explained. We have elaborated on various points throughout section 4. Preliminary results (page 20). We hope these revisions provide more clarity. Introduction - In the introduction, the importance of the study and the existing gap should be explained We have revised the text (page 5, paragraph 2) to reflect the existing gap and the importance of the study. >>>Furthermore, palliative care has a communication problem, as 54 years after its creation the concept is still misunderstood. Palliative care is currently perceived as "death" or "end of life”, and that misconception continues to generate feelings of bereavement, fear, and anxiety in society [7,8]. In Spain, the media may play an important role in this misunderstanding. An analysis of 600 Spanish newspapers (2009-2014) concluded that information on palliative care does not reflect its true nature, as the narratives used to talk about it are based on ideological and moral content such as the debate of issues like euthanasia [9]. The importance of this study stems from the need to find alternative routes to reach an alienated audience. Society receives a distorted version of the palliative care message and identifying a more direct channel of communication could be a solution. -The discussion needs more analysis and interpretation We agree and we have elaborated on several points throughout section 5. Discussion (page 21). -The written format of the article is not suitable in different sections. For example, the introduction is long and the discussion is short We have now both reduced the length of the Introduction and elaborate on the Results and Discussion. We think these changes now better the balance of the different sections. We hope that you agree. We would like to thank you one more time for allowing us to enhance our manuscript with your comments and queries. We have diligently incorporated your feedback and hope that these revisions persuade you to accept our submission. Sincerely, Ana Paula Salas Attachments Attachment Submitted filename: Response to reviewers.pdf https://doi.org/10.1371/journal.pone.0286343.r002
27 Mar 2023 Decision Letter - Samane Shirahmadi, Editor PONE-D-22-33602R1Educational innovation as a communication strategy in Palliative Care: a study protocol and preliminary resultsPLOS ONE Dear Dr. Salas, 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. ============================== ACADEMIC EDITOR: I have returned the manuscript to you to upload the correct file. Please submit your revised manuscript by May 11 2023 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, Samane Shirahmadi, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286343.r003
Revision 2
28 Mar 2023 Author Response ACADEMIC EDITOR: I have returned the manuscript to you to upload the correct file. We have corrected the file. Attachments Attachment Submitted filename: Response to reviewers.pdf https://doi.org/10.1371/journal.pone.0286343.r004
15 May 2023 Decision Letter - Samane Shirahmadi, Editor Educational innovation as a communication strategy in Palliative Care: a study protocol and preliminary results PONE-D-22-33602R2 Dear Dr. Ana Paula Salas Moreira, 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, Samane Shirahmadi, PhD Academic Editor PLOS ONE Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 ****** 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: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: It has made all the necessary corrections. Reviewer #2: The article entitle "Educational innovation as a communication strategy in Palliative Care: a study protocol and preliminary results" has been revised and changes based on comments are accepted. ****** 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 ******** Attachments Attachment Submitted filename: reviewer.docx https://doi.org/10.1371/journal.pone.0286343.r005
Formally Accepted
2 Jun 2023 Acceptance Letter - Samane Shirahmadi, Editor PONE-D-22-33602R2 Educational innovation as a communication strategy in Palliative Care: a study protocol and preliminary results Dear Dr. Salas Moreira: 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. Samane Shirahmadi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286343.r006

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