Dear Dr. Shutoh,

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.

==============================

ACADEMIC EDITOR: Please could the changes suggested by the reviewers be addressed. The reviewers have requested clarification in sections. The focus on patients with cancer also needs to be stated in the title. Please also address Reviewer 1's suggestion to include references to recent studies as you see fit as they seem relevant to the paper.

==============================

Please submit your revised manuscript by Jun 04 2025 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.

• 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 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,

Gursharan K Singh, PhD

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. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”).

For additional information about PLOS ONE ethical requirements for human subjects research, please refer to http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research .

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.

[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?

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

Reviewer #1: Thank you for the opportunity to review your paper “Congruence between preferred and actual place of death and its association with patients’ quality of death and dying: A nationwide survey in Japan”. This is a very important topic, which creates opportunities for improving care at the end of life.

My main suggestions include:

The manuscript is well-written and easy to follow. Really valuable and interesting results, further supporting the importance of end of life care planning and striving to fulfil patients’ preferences for place of care and death, to achieve qualitative care at the end of life. This study only focuses on patients with cancer, right? If so then this should be made clear in the title and the aim, and a motivation to why the study is limited to only patients with cancer and not other chronic illness with potential palliative care would be good.

Abstract:

- The abstract is informative and contains the essential information from the study.

Introduction:

- The introduction is easy to follow and contains adequate parts, and leads onto a rational and the research questions. The introduction could be developed and present more about common preferences for care at the end of life and place of death as well as quality indicators and qualitative care at the end of life. Pls see some recommended references below.

Methods:

- The methods section is well-written and clear.

- Good sample size, sound data and choice of methods.

- Data collection, how long after the death did the bereaved family members respond to the survey, was there any reasoning about when to send the survey invite? I see this is mentioned only as a limitation with regard to recall bias, a descroiåiption under methods would be helpful too. This is important for several reasons, firstly not too soon for ethical reasons of potentially upsetting the family members, secondly not too close to the yearly anniversary of the death for the same reason, thirdly the question of recall bias, if too long time has passed since the death.

- Setting, a setting description would be helpful describing the type of care available and the end of life in Japan and how healthcare is organised in Japan, if it is universal or not. There is a really high proportion of the patients that had died in PCU compared to results from place of death other countries, see examples of references for Europe below.

- Previous research has shown how the preference may change closer to death and how the last days or week may be spend in the preferred place, but that the actual death may take place in hospital or hospice care. Could you differentiate the place for care the last few days and the place of death or did family members only give one response for last few days of care and death together?

Results:

- Is there any information about the non-responders and if they differ from the responders?

- In total 11% died at home, and the preferred place of at home for death for patients was 40% and 26% for family members’ preferences. That is an interesting differences between actual place of death, and preferences, as well as the difference in preference between patients and family members.

- Intervention of palliative care team lower % than the 80% dying in PCU for achieved place, doesn’t PCU mean an automatic intervention of a palliative care team?

- Table 1, under relationship total there is no % presented for son, daughter in law etc…The % for education total most be wrong, does not add up to 100?

- Row 185: maybe state the place in connection with the % for this sentence “The congruence rates between caregivers’ preferred and actual place of death for their loved ones were 32.1%, 93.2%, and 38.7% for home, PCU, and acute-care hospital, respectively”.

- It would be good if you could clearer describe that the preferred place for care and death is the patient’s preference as reported by the family member as a proxy for the patient, but also that you asked about the family member’s preferences for where the patient should be care for and place of death, if I have understood this correctly as described under the results? This could be made clearer under data collection.

Discussion:

- Good summary of the results, and a well-written discussion which raises the most essential results.

- The differences between patients’ and family members’ preferences. Congruences between family members’ preferences and actual place of death?

Conclusion:

- In the future extend research to include other diagnoses with potential palliative care needs than only patients with cancer?

There are more recent studies on place of death as well as preferences thereof, the introduction and discussion could be strengthened with more reference and description of an international context.

Example studies place of death Europe:

Öhlén, J., Stina, N., Anneli, O., Stefan, N., Hanna, G., Johan, F. C., & Cecilia, L. (2025). Influence of palliative care policy on place of death for people with different cancer types: a nationwide’register study. PloS one, 20(3), e0320086.

Cohen, J., Pivodic, L., Miccinesi, G., Onwuteaka-Philipsen, B. D., Naylor, W. A., Wilson, D. M., ... & Deliens, L. (2015). International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. British journal of cancer, 113(9), 1397-1404.

O'Sullivan, A., Larsdotter, C., Sawatzky, R., Alvariza, A., Imberg, H., Cohen, J., & Öhlén, J. (2024). Place of care and death preferences among recently bereaved family members: a cross-sectional survey. BMJ Supportive & Palliative Care, 14(e3), e2904-e2913.

Cross, S. H., & Warraich, H. J. (2019). Changes in the place of death in the United States. New England Journal of Medicine, 381(24), 2369-2370.

Reviewer #2: Thank you for the opportunity to review the manuscript titled 'Congruence between preferred and actual place of death and its association with patients’ quality of death and dying: A nationwide survey in Japan.' The topic provides relevant information on factors influencing the quality of death. Please find my comments in the attached file.

**********

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:  Anna O'Sullivan

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

Attachments

Attachment

Submitted filename: POD_reviewer_2025_april8,2025.docx

Congruence between preferred and actual place of death and its association with quality of death and dying in advanced cancer patients: A nationwide survey in Japan

PONE-D-25-05638R1

Dear Dr. Shutoh,

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,

Gursharan K Singh, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: Thank you for considering my suggestions and making changes to your manuscript accordingly. I find all revisions that you have made satisfactory. Your manuscript is now significantly clearer, and I recommend it for publication.

Reviewer #2: Thank you for addressing my previous comments. I truly appreciate your hard work and thoughtful contribution to this important topic.Thank you again for your valuable work and contribution to the field.

**********

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:  Anna O'Sullivan

Reviewer #2: No

**********