Experiences of rehabilitation one year after breast cancer diagnosis–A focus group study from the ReScreen randomized controlled trial

Ing-Marie Olsson; Charlotta Dykes; Lisa Rydén; Ulrika Olsson-Möller; Marlene Malmström

doi:10.1371/journal.pone.0315814

Peer Review History

Original SubmissionJune 13, 2024
29 Oct 2024 Decision Letter - Eugenio Paci, Editor PONE-D-24-21825Experiences of rehabilitation one year after breast cancer diagnosis - A focus group study from the ReScreen randomized controlled trialPLOS ONE Dear Dr. Olsson, 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 Dec 13 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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Additional Editor Comments: This qualitative study evaluated in a very accurate and well carried on plan of qualitative analysis the experience with Breast Cancer of women already participating in a Randomized controlled trial (RESCREEN). The described relation between the experimental study and the qualitative study design is, in my opinion, very original and interesting. The analysis considered the two main categories and four sub-categories offering an informative interpretation of the findings. . The relevance of a proactive individual-based action is shown as a plus in the women perception of the health care. I appreciated the paper clear presentation. However, i suggest to consider the comments by the two reviewers preparing the second version of the paper. The non-participation rates, as suggested by a reviewer should be better discussed and possibly interpreted in relation to the distress fo the women. As the other reviewer suggested, in breast cancer care the issue of body images shouldt be more considered and experience reported. [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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: 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: 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: The results of the focus groups describe and underline very important themes in the field of oncological rehabilitation. The study contributes to bringing evidence on the importance of developing clinical practice towards a rehabilitation that is not only global and multidimensional, but above all guided and individualised. It seems to me that the need to combine validated screening tools, such as the DT, with a proactive and orienting intervention, which in clinical practice requires a reference figure for patients, has been well underlined. Half of the eligible patients involved in the RCT participate in the focus groups. What reflections can be made on this with respect to the topic of patients' needs? I would better specify the exclusion criterion for patients with cognitive impairment, as it is a rather frequent problem in people undergoing oncology rehabilitation. I would better describe the decision support tool referred to in line 135 For clarity, I would place the interview questions in the article rather than in separate material as supporting information Reviewer #2: Dear authors, thank you for your contribution. Here are my suggestions. - Introduction: you just cited body image within your focus of interest. However, this topic has not been explored. Please, add further details about it, knowing its impact on Quality of Life in cancer patients. See: Sebri et al., 2023; Sebri; Durosini, Pravettoni, 2023. Secondo, please, provide information regarding previous psyhcological interventions. See: Matchim et al., 2011; Mifsud et al., 2021. Third, please structure your hypothesis and goals in a well-done way. - Data analysis: please, provide more information about what type of analysis has been conducted in line with literature. Have you followed Braun and Clarke, for example? Literature has to be provided. References - Sebri, V., & Pravettoni, G. (2023). Tailored psychological interventions to manage body image: an Opinion study on breast Cancer survivors. International Journal of Environmental Research and Public Health, 20(4), 2991. - Sebri, V., Durosini, I., & Pravettoni, G. (2023). How to address the body after breast cancer? A proposal for a psychological intervention focused on body compassion. Frontiers in Psychology, 13, 1085837. - Matchim, Y.; Armer, J.M.; Stewart, B.R. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. Western J. Nurs. Res. 2011, 33, 996–1016. - Mifsud, A.; Pehlivan, M.J.; Fam, P.; O’Grady, M.; van Steensel, A.; Elder, E.; Gilchrist, J.; Sherman, K.A. Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors. Health Psychol. Behav. Med. 2021, 9, 498–526. ****** 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: elisa grechi 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.0315814.r001
Revision 1
18 Nov 2024 Author Response Additional Editor Comments: This qualitative study evaluated in a very accurate and well carried on plan of qualitative analysis the experience with Breast Cancer of women already participating in a Randomized controlled trial (RESCREEN). The described relation between the experimental study and the qualitative study design is, in my opinion, very original and interesting. The analysis considered the two main categories and four sub-categories offering an informative interpretation of the findings. The relevance of a proactive individual-based action is shown as a plus in the women perception of the health care. I appreciated the paper clear presentation. However, I suggest considering the comments by the two reviewers preparing the second version of the paper. The non-participation rates, as suggested by a reviewer should be better discussed and possibly interpreted in relation to the distress fo the women. As the other reviewer suggested, in breast cancer care the issue of body images should be more considered and experience reported. Answer: We sincerely thank the editor for the positive valuation of our study. We have adjusted our manuscript and developed the important areas suggested. Reviewer 1 The results of the focus groups describe and underline very important themes in the field of oncological rehabilitation. The study contributes to bringing evidence on the importance of developing clinical practice towards a rehabilitation that is not only global and multidimensional, but above all guided and individualised. It seems to me that the need to combine validated screening tools, such as the DT, with a proactive and orienting intervention, which in clinical practice requires a reference figure for patients, has been well underlined. Answer: We thank the reviewer for their positive appraisal of the manuscript. Reviewer 1: Half of the eligible patients involved in the RCT participate in the focus groups. What reflections can be made on this with respect to the topic of patients' needs? Answer: Thank you for pointing at this important matter. We have further developed the reasoning in the discussion section, see page 22-23, lines 508-513. Reviewer 1: I would better specify the exclusion criterion for patients with cognitive impairment, as it is a rather frequent problem in people undergoing oncology rehabilitation. Answer: Thank you. Those inclusion and exclusion criteria were for the ReScreen RCT, in which all the patients in the present study had participated. That inclusion took place before the start of treatment. Therefore, patients who experienced cognitive impairment as a result of treatment were included in the ReScreen RCT and their needs were addressed in the intervention. At the inclusion into the present focus group study, the only inclusion criteria were that the participants had fulfilled their participation in the RCT, and that at most two years have passed since the beginning of treatment. No questions related to the former (i.e. ReScreen RCT) criteria were asked about. We have now clarified this in the manuscript (page 8, lines 183-185). Reviewer 1. I would better describe the decision support tool referred to in line 135. Answer: Thank you for pointing this out, the decision support tool is essential for the ReScreen intervention which the women in the IG had received. We have now outlined the steps that the decision support tool entailed (page 7, lines 146-149) and clarified that more detailed information about the decision support tool can be found in the ReScreen RCT protocol (page 7, lines 154-155). Reviewer 1: For clarity, I would place the interview questions in the article rather than in separate material as supporting information. Answer: Thank you, we have now included a table containing the semi-structured interview guide in the manuscript (Table 2, page 10). Reviewer 2 Dear authors, thank you for your contribution. Answer: We thank the reviewer for their comments on the manuscript. Reviewer 2: Introduction: you just cited body image within your focus of interest. However, this topic has not been explored. Please, add further details about it, knowing its impact on Quality of Life in cancer patients. See: Sebri et al., 2023; Sebri; Durosini, Pravettoni, 2023. Answer: Thank you for the comment and the suggested references. One of the consequences of breast cancer treatment is indeed negative body image. In the Background, we expanded on the topic to illuminate its importance for the affected women with breast cancer (page 4, lines 77-81). Still, the focus of our study was on women’s experiences of rehabilitation and not on their experiences of consequences from diagnosis and treatment, nor specific consequences potentially affecting quality of life in this situation. Body image was not discussed during the interviews, and it was only briefly mentioned by participants. Therefore, within this study we cannot draw any conclusions about body image. This is now clarified in the discussion (page 22, lines 489-492). Reviewer 2: Secondo, please, provide information regarding previous psyhcological interventions. See: Matchim et al., 2011; Mifsud et al., 2021. Answer: Thank you. This is a topic described briefly in page 4, lines 91-92. Within this study we describe the need for tailored support, and navigation in health care system. That of course include psychological interventions, and in the background, we give a few examples, as well as examples for physical interventions. We have now increased this section with examples of psychological interventions which have had promising results on wellbeing among women with BC (page 4, lines 92-94). Reviewer 2: Third, please structure your hypothesis and goals in a well-done way. Answer: Thank you. In this qualitative study our aim was to explore the experience of rehabilitation after participating in an RCT. We aimed to generate insights and did not aim to test predefined hypotheses. The variation between the groups was a finding in this process of analysis, not a predefined hypothesis or goal, in line with the qualitative research design1. Reviewer 2: Data analysis: please, provide more information about what type of analysis has been conducted in line with literature. Have you followed Braun and Clarke, for example? Literature has to be provided. Answer: Thank you for pointing this out. This has been clarified (page 11, lines 221-222). 1Polit, D.F., & Beck, C.T. (2017). Essentials of Nursing Research – Appraising evidence for nursing practice (9th ed.). Wolters Kluwer. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0315814.r002
2 Dec 2024 Decision Letter - Eugenio Paci, Editor Experiences of rehabilitation one year after breast cancer diagnosis - A focus group study from the ReScreen randomized controlled trial PONE-D-24-21825R1 Dear Dr. Olsson, 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, Eugenio Paci, MD Academic Editor PLOS ONE Additional Editor Comments (optional): All comments adressed Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? 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 Reviewer #2: Dear authors, thank you for your revisions and the time-dedicated to them. I have no other comments to add. ****** 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.0315814.r003
Formally Accepted
15 Jan 2025 Acceptance Letter - Eugenio Paci, Editor PONE-D-24-21825R1 PLOS ONE Dear Dr. Olsson, 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. Eugenio Paci Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315814.r004

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