PONE-D-25-05025Exploring how and why attributes of existing and emerging early cancer detection tests influence experiences and participation among individuals at risk of socioeconomic disadvantage: a qualitative interview studyPLOS ONE

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Additional Editor Comments:

Dear authors, thank you very much for a well-written manuscript. However, the reviewers have identified some issues which I hope you will address.

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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: Dear Authors,

The investigation of users’ preferences regarding cancer detection tests among people at risk of socioeconomic disadvantage can contribute to overcoming barriers to access those tests. Please see my comments below.

When you respond to the comments, please provide your answers in a table with two columns, one with comments and the other with your answers. In the answer column, for each comment separately, include the revised text, in addition to your answer.

“Over 40% of individuals in the United Kingdom (UK) are diagnosed with cancer at an advance stage.(1)” Do you mean that 40% of the population is sick or that 40% of the diagnosed people are already in an advanced stage? Please revise the sentence to improve clarity.

Please correct the citation style. Insert the citation in the appropriate place: with the associated text, not after it (before “.” or “,”, not after them).

Please explain why it is important to know people’s preferences. It is important to motivate the usefulness of your study.

Who cares about people’s preferences? From a supply-demand perspective, when the supply (tests) is much lower compared to the demand (need for tests), the supply side doesn’t care what the consumers (patients) want. If there are 100 pairs of shoes on the market and 1 million barefoot people needing shoes, who cares what color they like or even what size?

Also, mention who should consider these preferences (scientists who create the tests, professionals who use it on patients, etc.).

Why did you focus only on people at risk of socioeconomic disadvantage? Do they represent the majority of sick people? What about the rest? Are they unimportant?

Can the results be extrapolated to people who are not at risk? Why/ Why not?

Please explain why the vignette task and think-aloud protocol are suitable for this study.

Please mention what data analysis methods you used and motivate your choice.

“This qualitative study aimed to use a vignette task and think…” The interview is not mentioned. Please add it. Also, it should be written that the study “used” instead of “aimed to use”.

“Qualitative semi-structured interviews supplemented with written descriptions of cancer detection tests, vignettes of tests scenarios and an adapted think-aloud protocol as participants were encouraged to deliberate between different test attributes” The predicate is missing. Please revise.

“People living in London were recruited via community-based methods between 01/02/2023 – 08/02/2024.” It is not clear what the month and the day are. Please use words for the months.

Please briefly explain what a vignettes task and a think-aloud protocol are.

Please explain what framework analysis is and why this was considered suitable and preferred to other methods for qualitative data.

“Participants were asked to read the descriptions of different types of early cancer detection tests and to think aloud while considering if anything about each test could be potentially off-putting from a patient perspective. Then participants were asked to engage with the vignette task and to think aloud while arranging the tests in order of preference that they thought the individual in the vignette would choose…. ” In addition to this description, please provide the interview script, the list with all questions used in the interview. Include the main questions, helping questions, etc. When presenting the questions, indicate the specific objective to which they respond. For example, it is mentioned that the study objective is to find out “how and why attributes of …. tests influence testing experiences and participation”. Show what questions focused on “how”, “why”, “experiences”, and “participation”.

This information supports the replication of the study.

“FMW is also a qualified GP.” What does GP mean?

The text in Fig is very blurred. Please improve it.

“Individuals discussed several attributes of early cancer detection tests that influence their capability and opportunity to take part based on their individual circumstances…..(the rest of the text)”. Vignettes are about imaginary people, Alex and Sam. The manuscript text presents the interview results as they were about the interview participants. This creates confusion. Please provide the necessary information to remove the confusion. How can you know they referred to themselves when they answered the questions about Alex and Sam and not to some imaginary people? What did you do to ensure that?

What do Q1, Q2, .. mean? Q from quote, or is this a code for each person? Please explain.

“Although, some highlighted that individuals who are less mobile may need the support from a relative (5).” Does “(5)” refer to the quote mentioned below this sentence? If yes, please write Q5.

The study objective is to find out “how and why attributes of …. tests influence testing experiences and participation”. Please present the results in a way that responds to the how and why, and highlights the experiences, and participation.

Reviewer #2: Thank you for the opportunity to review this manuscript, which is timely regarding the likely future direction of cancer early detection, and in considering it from the perspective of those (inverse care law) least served by current cancer screening/early detection (or with the most to potentially benefit).

It was great to see the involvement of public/patient members in the research material development - were they involved in any of the analysis or interpretation (I think from the coding description that they were not?). Was any other health literacy lens used for the materials given the target audience?

Thank you for the COREQ this was also useful.

I wasn't familiar with Think-Aloud Protocols - it would be useful if the description and a little more detail on this was provided at first use of the term.

It wasn't clear to me why participants needed a debrief sheet (line 164) - this is usually used in studies which involve deception?

It wasn't clear to me why framework analyses was used over other types of qual analyses (line 168) - another sentence or two justification would be helpful to the reader.

Appropriate limitations were outlined including the nature of the sample being relatively highly educated, urban, and white/english speaking.

I have two broad questions to the authors to consider whether any further clarification/detail in the manuscript may be useful:

The I-SAM (which includes COM-B) and CanTest are about informing/designing equitable screening/integrated programmes - from the protocol it appears the research wasn't originally designed using either framework - were these selected as part of the presentation of results? COM-B (the third part of I-SAM) appears to be the main aspect used in the results for this paper. Thinking about inequities, SES inequities as the focus of this work, the I-SAM proposes ways that theory and research can improve screening access in particular via patient and environmental factors - the background and the findings/discussion indicate a strong attention to the participant/patient factors but less on the opportunity side (particularly the environmental aspect/framing - opportunities to design programmes/approaches using these findings eg improving systems health literacy/information accessibility, how tests are offered and who by, ways to improve trustworthiness etc.

The second question was about including both screening (asymptomatic) and early detection (symptomatic) vignettes - do you think there was any confusion about this for the participants, and whether the symptomatic vignette impacted the perspectives/preferences more? Were the responses analyses separately for the different vignettes?

It was interesting that this study was about a broad range of test types across a broad set of potential screening/early detection settings - however one key note in the discussion (line 413) was that further research will be needed to understand perceived risk associated with tests in specific contexts. Given the potential nature of MCEDs/panels used for risk stratification/eligibility/screening/early detection do the authors think that studies in context will be possible?

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Reviewer #1: No

Reviewer #2: No

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Exploring how and why attributes of existing and emerging early cancer detection tests influence experiences and participation among individuals at risk of socioeconomic disadvantage: a qualitative interview study

PONE-D-25-05025R1

Dear Dr. Bonfield,

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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Kind regards,

Veincent Christian Pepito

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: Yes

Reviewer #2: (No Response)

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

Reviewer #1: N/A

Reviewer #2: (No Response)

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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: No

Reviewer #2: (No Response)

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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: (No Response)

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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: Dear Authors,

You responded to my comments. I do not have new ones.

Good luck with your research!

Kind regards,

The Reviewer

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: No

Reviewer #2: No

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