PONE-D-24-10353Treating the disease and meeting the person with the illness-patient perspectives of needs during infective endocarditis, a qualitative studyPLOS ONE

Dear Dr. Lindberg,

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.

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ACADEMIC EDITOR: I agree with the reviewers that the manuscript is well-written. The study applies to PLOS ONE readership. As noted by the reviewers, the table numbering must be corrected for the resubmitted manuscript.   ==============================

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Che Matthew Harris

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a study on infective endocarditis based on the perception of the patient who has made a series of considerations on general and technical aspects of his disease. The structure of the article is adequate in that it correctly addresses the state of the problem in the introduction, analyzes what has been published previously and the significance of the study in the discussion, and describes the possible limitations.

In this study, the authors delve into the feelings, doubts, expectations, demands, and desires of patients after being diagnosed with such a serious infection that usually requires prolonged hospitalization or surgery as infective endocarditis.

This study represents an opportunity to learn about all the subjective aspects surrounding this disease and its content may be of interest to clinicians.

As a result of the study, it is clear that patients need to perceive a deep knowledge of this pathology on the part of the physicians responsible for each case. In this sense, it seems that patients treated by specialists in infectious diseases are more satisfied than those treated by more general practitioners such as specialists in internal medicine. However, I believe that the time spent with patients, the patient's perception of diagnostic accuracy and the quality of care may not be so much related to the specialty of the treating physician, but rather to professional and personal aspects of each physician.

The demand for information regarding the impact on cardiac function, general physical and psychological deterioration that this infection produces in most patients has also been evident in this research.This article also allows physicians who treat infections in general and infective endocarditis in particular to reflect on patients' fears, anxieties and expectations of recovery. It is, therefore, an interesting investigation, but it does not analyze quantitative data on the clinical course of this serious infection.

Among the negative aspects of the work, the small number of participating patients and its long length stand out. Despite the size of the manuscript, we can point out that it is easy to read and that important aspects of the patient-physician relationship that are not usually addressed in conventional clinical practice are discovered.

As specific aspects, we highlight that Table 2 is doubly identified,

This article would also have a place in journals focused on health care, nursing journals and journals of a more general or informative nature. There is no clear research question or specific objectives, but rather a description of how a patient lives and feels when diagnosed with infective endocarditis.

Reviewer #2: Comments to the authors

Your paper is an atypical but very interesting paper on how the patients experience an episode of infective endocarditis. From the interview of 20 patients, you individualized 2 main axes of comments / patients’ needs: medical excellence and patient-centred care. You also identified 4 subsections for each.

This paper is very interesting, because it describes exactly the issues we encounter in our daily practice. Because IE is a complicated disease, we need to be highly specialised and reliable to manage patients the best as possible (for all steps of patient’s management: diagnosis, treatment and follow-up). Because IE medical therapy is long, we need to organise early return at home but with a reliable follow-up also during this period of treatment and during the early post therapy period. Because IE is a rare disease, we need to explain it clearly and comprehensively to patients and families and we have to take enough time for each of them and to accompany them during hospitalisation and after (patients’ need for knowledge, reorientation, health restoration and individualization)!

I have very few comments as your paper is really easy to read and well written.

The main point to be improved is the abstract as it does not clearly reflect the paper. It was the first thing I read, and I found it quite hard to understand… In the abstract result section, you should clearly identify each category, with its subcategories, reported on the same manner as in your paper (in the current form of the abstract, some ideas are separated by semicolon, others are complete sentences, it is really not clear! for instance, the first category is the need for medical excellence ; but when reading your abstract, I’m not able to identify the subcategories of this category…). You should use the same terminology as in table 3 (and not Table2), or as in the first paragraph of results, which is easier to understand. In the abstract conclusion, there are too many ideas in the same sentence: patients want to be treated in specialised units, they want to be discharged early, and the third idea is around outpatient care… Cut your sentences, “one sentence for one idea!” as I’ve always been taught!

Details:

The introduction paragraph may probably be shortened, as details about IE risk factors or complications are probably out of topic here. Do not be too strict when reporting percentages (Cardiac surgery is performed in 30% of cases…) add around 30% or give ranges (30-50%).

You should perhaps probably add somewhere in your discussion this paper on adherence to oral hygiene following an episode of IE which clearly shows that depression and cognitive impairment impact the adherence to important healthcare following an IE (Celestin B Determinants of adherence to oral hygiene prophylaxis guidelines inpatients with previous infective endocarditis Arch Cardiovasc Dis. 2023 Apr;116(4):176-182)

You should perhaps also suggest the help of psychologists during IE therapy or among IE teams.

In the conclusion, you could perhaps underline that individualizing these 8 axes of potential improvement in the daily management of IE patients is a great achievement that can open the door to other qualitative studies evaluating the impact of subsequent changes of behaviour of caregivers, as you mention in your last sentence.

The second sentence of your conclusion is not clear, the last part beginning with ”start the process” is not properly linked to the beginning of the sentence…

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Reviewer #1: Yes: Antonio Ramos-Martínez

Reviewer #2: Yes: Christine Selton-Suty

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Treating the disease and meeting the person with the illness - patient perspectives of needs during infective endocarditis, a qualitative study

PONE-D-24-10353R1

Dear Dr. Lindberg,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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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,

Che Matthew Harris

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed all my recommendations

I think it could be publishednit its current form

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Antonio Ramos-Martínez

Reviewer #2: No

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