Challenges experienced by health care providers working in both hospital and home-based palliative care units in Dhaka city: A multi-center based cross-sectional study

Mastura Kashmeeri; A. N. M. Shamsul Islam; Palash Chandra Banik

doi:10.1371/journal.pone.0306790

Peer Review History

Original SubmissionApril 27, 2024
11 Jun 2024 Decision Letter - Roberto Scendoni, Editor PONE-D-24-15132Date: April 8, 2024 Challenges experienced by health care providers working in both hospital and home-based palliative care units in Dhaka city: A multi-center based cross-sectional studyPLOS ONE Dear Dr. Kashmeeri, 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 Jul 26 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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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 study is well structured. The data are clearly reported. The various sections are written comprehensively and plainly. However, I feel that the authors need to better explore the topics of telemedicine and homecare better. There are numerous papers, including recent ones such as 10.3389/fpubh.2022.1095001, regarding these issues. Reviewer #2: Palliative care is paramount in the modern clinical field worldwide. This study aimed to explore the challenges faced by healthcare providers working in the palliative care unit in Bangladesh. The authors of the article have brought new and recent information that can be of use at the local level in the country. The article is prepared precisely and can be accepted for publication. ****** 6. 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Revision 1
14 Jun 2024 Author Response Response to reviewer Manuscript title Challenges experienced by health care providers working in both hospital and home-based palliative care units in Dhaka city: A multi-center based cross-sectional study Manuscript ID PONE-D-24-15132 Reviewer 1’s comments to the authors Comment1 : The study is well structured. The data are clearly reported. The various sections are written comprehensively and plainly. However, I feel that the authors need to better explore the topics of telemedicine and homecare better. There are numerous papers, including recent ones such as 10.3389/fpubh.2022.1095001, regarding these issues. Reply: Thank you for your suggestion. We have added your suggested information in the discussion. Line numbers 347 to 375 (From clean copy) Changes in the text The study revealed that 63.1% of respondents view the lack of home-based palliative care (HBPC) services as a significant challenge. Currently, the super-specialized hospital, BSMMU, is the sole provider of home-based services in Bangladesh, resulting in cost savings for the healthcare system. In a 2019 study conducted by Biswas et al., it was emphasized that home-based palliative care (HBPC) services play a crucial role in improving the quality of life (QOL) for terminally ill patients.[33] Similar positive effects were also observed in various regions around the world, regardless of the patients' access to family and psychological support systems. [33-35, 37-39]. However, many other centers encounter challenges such as limited manpower and financial constraints, inadequate home-oriented guidelines. In present HC, patients are enrolled based on preset (PPS below 50, distance, absence of caregiver) criteria and receive 2-3 visits per month from healthcare professionals on need basis. The study also agrees that doctor visits are infrequent, telemedicine services are available but inadequate as it fail to enhance HP’ s work satisfaction. [33-36]. Nevertheless, almost two-thirds of participants expressed dissatisfaction with the provided services due to the lack of practical home-oriented guidelines (68.1%) and an effective telemedicine service (47.7%) system. Research in Dhaka, Bangladesh, indicated that existing home-based care services fail to effectively manage symptoms in over half of the patients, underscoring the necessity for proper treatment protocols and improved communication. Different published studies agreed with the notion that home care for elderly and non-self-sufficient patients is vital in addressing the growing demand for health services due to the aging population and reducing the strain on hospitals. [40-41,43-44]. Multi-professional home-based palliative care teams, comprising doctors, nurses, physiotherapists, psychologists, and healthcare assistants, are crucial for addressing the complex health and social needs of patients also compatible with other published studies. [33, 41]. Additionally, the importance of monitoring patients digitally, both in healthcare facilities and at home, has become more significant, particularly in the wake of the pandemic. Digital applications play a vital role in enhancing patient compliance and improving cost efficiency. [42,43]. Furthermore, digital applications can aid individuals with disabilities, ensuring their full participation in social, relational, and work activities. However, developing a user-friendly digital system is time-consuming, costly, and may breach user privacy, so feasibility testing is necessary depending on societal context. [41, 44-47]. Reviewer 2 ’s comments to the authors Comment 1 : Reviewer #2: Palliative care is paramount in the modern clinical field worldwide. This study aimed to explore the challenges faced by healthcare providers working in the palliative care unit in Bangladesh. The authors of the article have brought new and recent information that can be of use at the local level in the country. The article is prepared precisely and can be accepted for publication. Reply: Thank you for your compliment we feel greatly honored. Editor’s comments to the authors The authors, in the conclusion section, should better explain how to raise awareness among healthcare professionals working in the Palliative Care Unit with the concepts introduced. Ex: subject them to periodic questions? Carry out training courses? Ensure internal audits? Implement contact with patients? Please discuss these aspects further. Please expand the number of references regarding telemedicine and home care as suggested by the reviewer. Reply: Thank you for your suggestion. We have added your required information in the conclusion Line numbers 392 to 400 (From clean copy) Changes in the text Palliative care has been around for over a decade, yet it still does not receive the recognition it deserves. It is not only meant for patients at the end of their life. By providing adequate vocational training and awareness programs, knowledge can be built. Raising awareness among palliative care providers is vital for improving the quality and efficiency of care. Strategies include workshops, continuing medical education, online platforms, multidisciplinary team meetings, mentorship programs, and peer support groups. Access to guidelines, telemedicine, mobile apps, and regular feedback mechanisms are also important. Additionally, community engagement and policy advocacy are needed to promote palliative care education and resources. Response to journal requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates Reply: Thank you for the recommendation, changes have been made as per requirements. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). Reply: Thank you for raising the point, changes have been made to the clean copy manuscript ethical consideration. Line numbers 135 to 136 (From clean copy) Changes in the text Interested participants were required to provide informed written consent before proceeding to the next steps of the questionnaire. 3. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Reply: Thank you for raising the point, changes have been made to the clean copy manuscript. Line numbers 406 to 408 (From clean copy) Changes in the text The authors received financial support from the Bangladesh Medical Research Council (BMRC). However, the funders had no involvement in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. 4. 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. Reply: Thank you for raising the point, changes have been made to the clean copy manuscript in the reference section with DOI. Line numbers 414 to 560 (From clean copy) Attachments Attachment Submitted filename: Response to reviewer.docx https://doi.org/10.1371/journal.pone.0306790.r002
24 Jun 2024 Decision Letter - Roberto Scendoni, Editor Challenges experienced by health care providers working in both hospital and home-based palliative care units in Dhaka city: A multi-center based cross-sectional study PONE-D-24-15132R1 Dear Dr. Kashmeeri, 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, Roberto Scendoni Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0306790.r003
Formally Accepted
8 Jul 2024 Acceptance Letter - Roberto Scendoni, Editor PONE-D-24-15132R1 PLOS ONE Dear Dr. Kashmeeri, 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 Dr. Roberto Scendoni Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306790.r004

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