Sources of diagnostic delay for people with Crohn’s disease and ulcerative colitis: Qualitative research study

AWARE-IBD Diagnostic Delay Working Group

doi:10.1371/journal.pone.0301672

Peer Review History

Original SubmissionSeptember 12, 2023
27 Nov 2023 Decision Letter - Valérie Pittet, Editor PONE-D-23-28268Sources of diagnostic delay for people with Crohn’s disease and ulcerative colitis: qualitative research studyPLOS ONE Dear Dr. Ezaydi, 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 Jan 11 2024 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. 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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. Note from Emily Chenette, Editor in Chief of PLOS ONE, and Iain Hrynaszkiewicz, Director of Open Research Solutions at PLOS: Did you know that depositing data in a repository is associated with up to a 25% citation advantage (https://doi.org/10.1371/journal.pone.0230416)? If you’ve not already done so, consider depositing your raw data in a repository to ensure your work is read, appreciated and cited by the largest possible audience. You’ll also earn an Accessible Data icon on your published paper if you deposit your data in any participating repository (https://plos.org/open-science/open-data/#accessible-data). 3. 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. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). 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In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 6. 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. [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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: In the paper Sources of diagnostic delay for people with CD nd UC: qualitative research study, a framework analysis of semi-structured interviews with 20 adult IBD patients is presented, aiming to delineate sources of diagnostic delay. Both patient’s and doctor’s DD have been addressed. Strengths: • Extensive ‘open’ interviews to identify potential sources of delay in the patient journey (=narrative synthesis) • Addressing current novelties (or, in other opinion, threads) of medicine, including cure-referral, waiting lists, digitalization, language barriers and triage Weaknesses: • Specificity (and sensitivity) as patients with similar complaints but not having IBD were not included as comparator • ‘Test variability’ of interviewers is unclear • Would the patient journey be smoother when applying -currently usual- a priori (less invasive, threatening) risk factor identification, such as family history of IBD and fecal calprotectin measurement? Or would this journey be at least more specific for IBD patients? Due to what reason concludes the author that awareness of IBD would be a relevant factor, or knowledge increment of clinicians, to improve the IBD patient journey? Specific remarks: Abstract; The conclusion is not necessarily deductible form the presented data. Methods: How was diagnostic delay precisely defined? Were specific pretest applied or excluded in the patients journey, e.g. fecal calprotectin assessment? Did telephone interviewing as compared to Google Meeting lead to different outcomes/sources ? Why was the cohort approached by two different communication means? Results: Expression of discomfort was present in 7 out of 20 participants ? Or did the 7 not expressing comfort were neutral? Anyhow, how is this number as compared to non-IBD ‘abdominal’ patients? Line 305-312 seem to be more explanatory than rough data presentation. Why in the results section? Are other explanation possible or even likely? What about 25% of participants denying tests or investigations (line 314); representative for the health care seekers? Line 347; is fecal testing unfamiliar/uncommon in the Sheffield area? Discussion: The Safer-Andersen and Pedersen models are relevant for insiders, but a short introduction night be helpful, as holds true for psychophysiological comparison. It might be better to address why these models have been applied. Line 389 Is this a cognitive, a conative or an affective interpretation of the participant’s interview? Reviewer #2: The topic of this manuscript is of clincal importance and sounds very intersting. Because it is not the field of my expertice, I only have a fewer minor comments: is the dignostic delay in IBD statistically signficant? ****** 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: Yes: AA van Bodegraven 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. https://doi.org/10.1371/journal.pone.0301672.r001
Revision 1
22 Dec 2023 Author Response Thank you for the helpful and constructive comments regarding the resubmission of this manuscript. We have incorporated the feedback into the manuscript and feel that the paper is much improved as a result. We will now take each comment in turn and demonstrate how the concerns have been met on a case-by-case basis. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The formatting has been revised according to the style requirements. 2. 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. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. We have not shared de-identified interview transcripts, as this is concordant with University of Sheffield processes for trial data sets. Furthermore, our participant consent forms and information sheets (which have been approved by Health and Care Research Support Centre, Wales Research Ethics Committee 3) stated that the transcripts would be stored securely for 10 years at the University of Sheffield, and only shared in an anonymised form if considered appropriate by the research team. Therefore, uploading interviews transcripts onto a publicly accessed data repository would oppose what participants agreed to in the informed consent procedure. Data requests may be sent to ctru@sheffield.ac.uk. 3. Please amend your authorship list in your manuscript file to include author Naseeb Ezaydi. This manuscript is being submitted under a group authorship ‘AWARE-IBD Diagnostic Delay Working Group’. The members of this group are listed in the acknowledgements section including Naseeb Ezaydi. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. The methods section has been amended to include the full name of the ethics committee who approved the study and the verbal consent procedure. As shown below: “The study received ethical approval from the Health and Care Research Support Centre, Wales Research Ethics Committee 3 (16/08/2021). Informed consent was obtained verbally before all interviews. Consent was recorded onto an encrypted dictaphone and also recorded onto a paper consent form, a copy of which was sent to the participant.” Lines 157-161. 5. 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. References 88 – 93 have been removed from the reference list as they are not cited in the main text. Reviewer 1 comments: Specific remarks: Methods: How was diagnostic delay precisely defined? We have added the following to line 104: “For the purpose of this study, our funder defined diagnostic delay to have occurred when a person’s diagnosis by a secondary care specialist took longer than 12 months from first onset of symptoms.” Were specific pretest applied or excluded in the patients journey, e.g. fecal calprotectin assessment? This was a naturalistic study in which we asked participants what had happened to them. There was no attempt to prospectively manipulate pathways. Some participants will have received faecal calprotectin assessment; other will not. It was this variation in practice that the study was designed to detect. Did telephone interviewing as compared to Google Meeting lead to different outcomes/sources ? Why was the cohort approached by two different communication means? We have added the following at line 165: “To mitigate barriers to inclusion and participation, participants were given a choice of semi-structured interviews conducted by telephone or Google Meet...” We did not identify any difference in the richness of interviews or the inferences we drew from them that could be related to the medium of their conduct. Results: Expression of discomfort was present in 7 out of 20 participants ? Or did the 7 not expressing comfort were neutral? Anyhow, how is this number as compared to non-IBD ‘abdominal’ patients? We are struggling to respond to this comment. Only one variant on the word, “discomfort” appears in our manuscript, in Table 2, and not in connection with a frequency count. We have checked all instances of frequency counts of n=7 and n=13 and none of them appear to be to do phenomena that are synonymous with discomfort. We do not understand the other two questions. Line 305-312 seem to be more explanatory than rough data presentation. Why in the results section? Are other explanation possible or even likely? What about 25% of participants denying tests or investigations (line 314); representative for the health care seekers? Sometimes in qualitative research it is useful, and accepted practice, to triangulate to the published literature during the Results. However, we realise this is unsettling to some reviewers. In deference to the reviewer, we have moved these lines to Line 431 of the Discussion. Line 347; is fecal testing unfamiliar/uncommon in the Sheffield area? In the journal’s PDF version of our original submitted manuscript, Line 347 reads. “347 inadequate pain control, or translation problems. Four discussed being told or”. We are struggling to understand the context of the reviewer’s question. Faecal testing is relatively common and familiar in the Sheffield area. However, this paper seeks to show variation in practice, and unevenness in its application. Discussion: The Safer-Andersen and Pedersen models are relevant for insiders, but a short introduction night be helpful, as holds true for psychophysiological comparison. It might be better to address why these models have been applied. We have inserted the following, where these models are first introduced: “Psychophysiological Comparison Theory predicts that, when people notice symptoms, they try to understand their cause. They mentally compare the symptoms to their existing knowledge about illnesses. However, people are more likely to favour explanations that are less threatening. People can also describe their symptoms inaccurately because they have different perspectives and viewpoints when translating their subjective experiences into words. Social influences, especially wanting to meet certain expectations, can further change how people describe their symptoms. The Diagnostic Triage Model shows how people journey from first noticing symptoms to getting a diagnosis. There are decision points along the way - by you, your regular doctor, and specialist doctors. At each point, judgments are made – by people with symptoms, by generalists, by specialists, about how urgently the person need care. The model maps out the ups and downs on the path to diagnosis. Symptoms, people’s instincts, who they talk to, and interactions with doctors all impact the speed of progress. Delays happen when concerns are minimised; faster diagnosis comes through appropriate worry and referrals. The model aims to explain why some diagnosis journeys are smooth and some frustratingly prolonged. We chose these theories because they have evidential and coherential virtues[30]: they have shown good fit with the empirical evidence across a range of settings; and, they posit factors that plausibly cause the effect (diagnostic delay) in question which are coordinated in an intuitively plausible whole. It is appropriate to combine two theories or models to overcome the inherent limitation of each[31] - Psychophysiological Comparison Theory focusing on the patient and the Diagnostic Treatment Model on the wider system.” Line 389 Is this a cognitive, a conative or an affective interpretation of the participant’s interview? Line 389 in the journal’s PDF reads: "389 Change in the diagnosis prototype was changed by individuals after research - particularly on-line." The sentence appears in a discussion section and – as the use of the plural shows – relates to a generalisation based on several interviews, not that of a single participant. Our understanding is that this cognitive-conative-affective triad relates to German faculty psychology and the association psychologist, and that it is less in use since the early Twentieth Century (Hildard ER, Journal of the History of the Behavioral Sciences 16 (1980):107-117). We do not understand Psychophysiological Comparison Theory as consistent with the triad – it is a modern cognitive-affective theory, with no explicit reference to conation, and much more emphasis on cognition. For these reasons we do not feel comfortable applying synoptic/categorical theories to our data in the way the reviewer requests. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0301672.r002
12 Feb 2024 Decision Letter - Valérie Pittet, Editor PONE-D-23-28268R1Sources of diagnostic delay for people with Crohn’s disease and ulcerative colitis: qualitative research studyPLOS ONE Dear Dr. Ezaydi, 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 Mar 28 2024 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, Valérie Pittet, PhD 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. [Note: HTML markup is below. Please do not edit.] 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: (No Response) ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 ****** 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 ****** 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 raised questions have been adequately addressed to improve the value of the paper for IBD care providers, such as I. Particularly, the elaboration of the used test methods is very clear. Although I gradually understand to be old-fashioned ( I plea guilty) and Germanlike (I plea not guilty) with part of my questions (19th century German theory), and to be rather anally fixated to usually put interpretation of findings in the discussion section (indeed a rather German, even Habsburgian concept, reflecting on mishappens with my parents, and as such not a major issue ;-). I read the paper with great interest and joy, whilst reflecting on my own IBD-practice. My apologies for unclear comments. The authors question what was meant by "Expression of discomfort was present in 7 out of 20 participants?.....non-IBD 'abdominal' patients? ". The questions were mentioned to address line 295. 'Thirteen patients expressed comfort in discussing symptoms', leaving potentially 13 with discomfort. Or had they/these 13 no particular mention of any feeling? The third question was asked to clarify whether this 'discussion on symptoms' was (felt to be) socially embarrassing (in general whilst having abdominal complaints or was it a specific feature of IBD patients only?). The second enigmatic question concerned fecal testing (apparently I made a typo with the correct number of the particular line). In my country GP-initiated (laboratory) diagnostic work-up of abdominal complaints includes fecal calprotectine assessment, being an important step for referring for colonoscopy at short notice (or a red flag for rapid / prioritized specialist consultation). In Table 3 only 6 check marks are indicated for 'Elevated calprotectin', making it difficult to interpret its meaning in standard Welsh (Sheffield) practice. Hopefully, with this, the context of these particular questions is clarified. ****** 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: Yes: AA van Bodegraven ******** [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.0301672.r003
Revision 2
1 Mar 2024 Author Response Thank you for the helpful and constructive comments regarding the resubmission of this manuscript. We have responded to the reviewer comments below: 1. The authors question what was meant by "Expression of discomfort was present in 7 out of 20 participants?.....non-IBD 'abdominal' patients? ".The questions were mentioned to address line 295. 'Thirteen patients expressed comfort in discussing symptoms', leaving potentially 13 with discomfort. Or had they/these 13 no particular mention of any feeling? The third question was asked to clarify whether this 'discussion on symptoms' was (felt to be) socially embarrassing (in general whilst having abdominal complaints or was it a specific feature of IBD patients only?). We have added the following sentence to clarify expressions of comfort and discomfort amongst the twenty participants – lines 284 – 286. “Of the remaining seven participants, six expressed some discomfort in discussing symptoms during their consultations and one could not recall how they felt.” Although we want to clarify that these were qualitative interviews involving open questions, so participants were not restricted to comfort or discomfort as responses. Regarding whether embarrassment during discussion of symptoms is a specific feature of IBD patients only, all twenty participants had some form of Crohn’s disease or ulcerative colitis. Interview questions focused on participant’s experiences discussing symptoms before their diagnosis, which often took the form of abdominal complaints. Therefore, we cannot say whether embarrassment when discussing symptoms is a specific feature of IBD patients only. 2. The second enigmatic question concerned fecal testing (apparently I made a typo with the correct number of the particular line). In my country GP-initiated (laboratory) diagnostic work-up of abdominal complaints includes fecal calprotectine assessment, being an important step for referring for colonoscopy at short notice (or a red flag for rapid / prioritized specialist consultation). In Table 3 only 6 check marks are indicated for 'Elevated calprotectin', making it difficult to interpret its meaning in standard Welsh (Sheffield) practice. Hopefully, with this, the context of these particular questions is clarified. Calprotectin is now a part of the routine work-up of suspected inflammatory bowel disease with general practitioners following local specialist guidance. This paper seeks to show patient reported variation in practice, and unevenness in its application. Clinicians in our study did not have full access to GP notes. Journal requirement: 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. References list and citations have been corrected. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0301672.r004
20 Mar 2024 Decision Letter - Valérie Pittet, Editor Sources of diagnostic delay for people with Crohn’s disease and ulcerative colitis: qualitative research study PONE-D-23-28268R2 Dear Dr. Ezaydi, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Valérie Pittet, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0301672.r005
Formally Accepted
13 May 2024 Acceptance Letter - Valérie Pittet, Editor PONE-D-23-28268R2 PLOS ONE Dear Dr. Ezaydi, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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 PD Dr. Valérie Pittet Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0301672.r006

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