Advance personal planning knowledge, attitudes, and participation amongst community-dwelling older people living in regional New South Wales, Australia: A cross-sectional survey

Emilie C. Cameron; Nola Ries; Amy Waller; Briony Johnston; John Anderson; Jamie Bryant

doi:10.1371/journal.pone.0309152

Peer Review History

Original SubmissionNovember 21, 2023
16 May 2024 Decision Letter - Yogesh Kumar Jain, Editor PONE-D-23-38030Advance personal planning knowledge, attitudes, and participation amongst community-dwelling older people living in regional New South Wales, Australia: a cross-sectional surveyPLOS ONE Dear Dr. Cameron, 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. ============================== The manuscript has received an overall positive feedback from the reviewer, but warrants few additional refinements. You are requested to please provide the revised manuscript as per the comments below, for further processing and consideration.============================== Please submit your revised manuscript by Jun 30 2024 11:59PM. 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Kind regards, Yogesh Kumar Jain, MPH 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. In the online submission form, you indicated that the data that support the findings of this study are available on request from the corresponding author, Emilie Cameron, or by request to the Hunter New England Health Human Research Ethics Committee via HNELHD-ResearchOffice@health.nsw.gov.au. The data are not publicly available due to ethical restrictions on sharing the data that could compromise the privacy of research participants. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Dear Authors, The manuscript has received an overall positive feedback from the reviewer, but warrants few additional refinements, such as explanations of EPOA, ACD, and EG; clarification of selection process; information about the reliability and scoring of study tools; and approach to handling missing data. You are requested to please provide in line explanations and justification of omissions wherever necessary for further processing. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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: No ****** 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 ****** 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: Thank you, editor, for inviting me to review the paper. The paper makes a good impression at the beginning but requires improvements in other parts of the manuscript. The following are my suggestions for the improvement of this manuscript: Abstract: Please consider including the type of data analysis involved and the questionnaires for data collection. Introduction: I recommend providing additional explanations about EPOA, ACD, and EG, including their benefits, disadvantages, and differences. Methodology: the authors should clarify how the random selection process was performed. The statement” organisations identified potentially eligible members 119 on their membership list”, does not align with random sampling principles. For Facebook advertisements, how do you ensure that only older people residing in and around selected towns respond to the surveys? Additionally, please include information about the reliability and scoring of the study instruments. Lastly, describe your approach to handling missing data. Results & Discussion: Please provide examples of countries for the 'other' category in the demographic data. Avoid using too many abbreviations like EPOA, ACD, and EG as they can disrupt the flow of the manuscript; consider using the full terms instead. For the statement ‘This study revealed several concerning deficiencies in knowledge of older adults about the legal 327 aspects of APP instruments”, please elaborate on how this compares to previous findings. Please include recommendations for future studies. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [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. 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Revision 1
3 Jun 2024 Author Response Thank you for providing reviewer comments on our manuscript. We appreciate the insights provided by the reviewer and have worked to address all suggestions made. Our responses to the comments are provided below and have been made in the revised manuscript. Editor’s comments 1. Please ensure that your manuscript meets PLOS ONE's style requirements. We have checked the document and are confident that it meets the requirements. 2. In the online submission form, you indicated that the data that support the findings of this study are available on request from the corresponding author, …. The data are not publicly available due to ethical restrictions on sharing the data that could compromise the privacy of research participants. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. Making the data public at this point would breach compliance with the approved protocol by the research ethics board. In the ethical approval to this study it states that: “De-identified data may be made available for secondary analysis however separate ethics approval will be sought beforehand. Where data is used for further analysis, it will not contain any identifying information. Only grouped data will be presented in any reports of publications arising from this research.” This is what has been communicated to participants in the Participant Information statement. We therefore request that an exemption be made and the original statement on data availability stands. 2. Please review your reference list to ensure that it is complete and correct. We have checked the reference list. Reviewer comments: • Abstract: Please consider including the type of data analysis involved and the questionnaires for data collection. We have added a description of the questionnaires used and data analysis performed to the abstract. (page 2 line 30) “The survey was developed for the study based on previous work. It included questions about the participant and their experiences with APP including their participation, knowledge, confidence and attitude. Poisson regression modelling was conducted to explore the relationship between APP participation and APP knowledge, confidence and attitudes as well as the participant characteristics associated with APP participation.” • Introduction: I recommend providing additional explanations about EPOA, ACD, and EG, including their benefits, disadvantages, and differences. We have added further explanation about the documents in the introduction (Page 4 line 68). “Having APP documents in place before they are needed helps to ensure that decisions are made in line with a person’s values and preferences [2]. Knowing who is responsible for making these decisions through the appointment of substitute decision makers, including an Enduring Power of Attorney for decisions about property and finances and an Enduring Guardian for personal and medical care, helps to reduce stress and avoid disputes. Having a person’s wishes documented in an Advance Care Directive can help to give the decision maker confidence in their decisions and make them aware of the person’s preferences so they can make fully informed decisions. A will comes into place after death and documents the distribution of a person’s possessions and assets. [2, 23]” • Methodology: the authors should clarify how the random selection process was performed. The statement” organisations identified potentially eligible members 119 on their membership list”, does not align with random sampling principles. As this was a cross sectional survey the aim is not to randomly select participants but to get a representative sample. Participants were selected from a number of different regions and organisations and using different methods to try to ensure this. • Methodology: For Facebook advertisements, how do you ensure that only older people residing in and around selected towns respond to the surveys? Facebook advertisements were set to only display to the specific population group that we were targeting. All participants provided their age and postcode at the beginning of the survey. They were later asked for their date of birth and suburb as a check of the information provided. The details of selected participants were also verified through a phone call. We have added further details to the methods (Page 8 line 149). “The eligibility of participants was checked by collecting their date of birth and postcode. A selection of participants were called to verify their details.” • Methodology: Additionally, please include information about the reliability and scoring of the study instruments. We have clarified that the survey was developed for the study (Methods page 8 line 153). We have also added further details about the instrument on which it is based (Page 8 line 158). “Scoring of items was based on the Advance Care Planning Engagement Survey which demonstrates good reliability and validity [41].” • Methodology: Lastly, describe your approach to handling missing data. On page 10 of the methods we have stated for each score how missing values were handled. A change has been made to help clarify this. For some demographic variables the proportion of missing values was greater than 5% therefore a sensitivity analysis (as explained on page 10 line 211) was conducted. We have added more to explain this in the results section (page 15 line 286). “The sensitivity analysis did not change the result for any other variable.” • Results & Discussion: Please provide examples of countries for the 'other' category in the demographic data. We have added the largest “Other” category (UK) to the demographics table (page 12, Table 1). All other countries had just 1 person from them. • Results & Discussion: Avoid using too many abbreviations like EPOA, ACD, and EG as they can disrupt the flow of the manuscript; consider using the full terms instead. We have removed many of the abbreviations throughout the manuscript using the full version instead, including EG, EPOA, ACD and ACP. • Results & Discussion: For the statement ‘This study revealed several concerning deficiencies in knowledge of older adults about the legal 327 aspects of APP instruments”, please elaborate on how this compares to previous findings. We have added a sentence and references highlighting the results of other studies (Page 18 line 351) “Other studies have found a similar low level of knowledge about APP across different population groups [51-54]” Literature also highlights the risks that may arise from misunderstanding APP instruments and the need for enhancing knowledge to ensure APP achieves its intended purposes [55].” • Results & Discussion: Please include recommendations for future studies. We have included a statement in the discussion on future directions. (page 19 line 373) “Future work should investigate the effectiveness of such strategies.” We hope these responses meet with your approval and look forward to receiving your response. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0309152.r002
7 Aug 2024 Decision Letter - Shadia Hamoud Alshahrani, Editor Advance personal planning knowledge, attitudes, and participation amongst community-dwelling older people living in regional New South Wales, Australia: a cross-sectional survey PONE-D-23-38030R1 Dear Dr. Emilie Cameron 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, Shadia Hamoud Alshahrani, PhD Academic Editor PLOS ONE 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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 #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 #2: 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 #2: Thank you for the opportunity to review the manuscript. The manuscript is comprehensively revised. Few amendment to clarify methods: 1. Self-reported APP - how many item? 2. Frailty - scale used? 3. Health and legal service use- how many items? ****** 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 #2: No ******** https://doi.org/10.1371/journal.pone.0309152.r003
Formally Accepted
9 Aug 2024 Acceptance Letter - Shadia Hamoud Alshahrani, Editor PONE-D-23-38030R1 PLOS ONE Dear Dr. Cameron, 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. Shadia Hamoud Alshahrani Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309152.r004

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