Dear Dr. Day,

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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?

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

Reviewer #1: Yes

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Navigating Cancer: Insights from Patient Journey Mapping

Thank you for the opportunity to review this interesting and important topic. Research shows that cancer is the world’s biggest killer, with 10 million deaths per year due to the disease.

Comments

Abstract

The abstract does provide a background and introduction of the study.

Main study

Introduction

The presence of important and current background information on the study topic is noted and appreciated.

Methods

Mapping patient journey is an interesting and unique research design appropriate to understand patients’ cancer journeys across the continuum, highlight disparities, and gaps in access and care. Sampling, data collection instruments, data collection and analysis methods have been clearly described and applied well to yield the reported results. However, researchers are not explicit as to how participant recruitment and data collection was done in the three different provinces. How it is written can confuse the reader, e. g, “map of the municipality where data collection took place” can make one think data collection took place in one province and one municipality.

Ethical considerations

Ethical considerations pertaining to person covered principles of autonomy, informed consent, anonymity and confidentiality. However, pertaining to institution, only ethical clearance from a university and nothing is mentioned about approval by provincial gatekeepers.

Results

Clearly and logically articulated to facilitate repeatability.

Discussion & implication

Discussion relates results to available literature and is placed well within the context of existing research including what is happening in the SA health system.

Conclusions

This section reflects on the discussion section above.

References

Sources have been appropriately referenced, in text and in the list of references at the end.

Recommendation

Based on the above comments, it is recommended that this paper be accepted with minor corrections.

Reviewer #2: Thank you for the opportunity to review this beautifully written paper. The authors have provided a very clear description of the cancer situation in South Africa, the patient journey mapping process they chose, underpinned by a strengths based narrative.

The very clear description of the process of individual mapping, collective mapping, producing a collective visual journey map, coding and theme development using interpretive phenomenological analysis nVivo, informed by theoretical underpinnings of intersectionality and health equity makes this paper a very important paper in the emerging and growing field of journey mapping, and also in cancer care.

Introduction provides a clear picture of the situation relating to breast and cervical cancer in South Africa, and the use of journey mapping to explore the cancer journeys of people internationally.

Research design is well described and the SA health system context provided. Is very helpful for an international readership. The theoretical underpinnings of intersectionality and health equity give the study and paper depth, and as discussed moves from a uni-dimensional view of their lived experiences to a multidimensional nuanced understanding of their cancer journey.

The description of the pilot study and participant preferences is very helpful for other studies. The three step process undertaken in focus groups is clearly and clearly explained (it sounds very effective).

The analysis process and identification of codes and themes using interpretive phenomenological analysis and NVivo is well described.

Findings – very comprehensive.

Line 258 – re pain management being insufficient – was this for both public and private patients?

Figure 1 – very effective visual summary

Discussion

The authors could perhaps include more emphasis on specific recommendations fro the women, or themselves for health system improvement in the discussion. (optional due to word length)

Conclusion – I encourage the authors to lengthen the conclusion by a few sentences to more fully emphasise the key points they would like the reader to take away. This might include the voices, the patient journey mapping method incorporating both individual and collective mapping and emerging themes, underpinned by theoretical underpinnings of intersectionality and health equity to identify both strengths and limitations of health care interactions, services and systems.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: NAVIGATING CANCER CARE REVIEWERS REPORT NM.docx

Navigating Cancer: Insights from Patient Journey Mapping

PONE-D-25-30735R1

Dear Dr. Day,

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,

Taiwo Opeyemi Aremu, MD, MPH, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

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

Reviewer #2: Yes

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

Reviewer #2: N/A

**********

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

The PLOS Data policy

Reviewer #2: No

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

Reviewer #2: Yes

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Reviewer #2: Thank you for the opportunity to review the revised version of this manuscript.

This paper clearly describes the research approach, use of journey mapping, findings, discussion and conclusion, adding to both journey mapping and cancer literature.

Changes to the manuscript have responded to reviewer comments.

Removal of original Table 1 provides de-identification of participants.

Line 297 – check table number (says 9, should be 1).

The added sections in Discussion identifies recommendations from participants more strongly. I considered whether they are findings or discussion but think they fit well in discussion.

The re written conclusion is more powerful.

Acknowledgement inclusions are important.

Conflict of interest statement wording could be altered slightly. Perhaps – ‘we maintained a strong adherence to PLOS ONE policies on sharing data and materials.’

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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: Yes: Janet Kelly

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