Medication multiple experiences of elderly patient with multiple chronic condition: A qualitative meta-synthesis

Guo Xin; Wang Yuanxing; Wu Jiaming; Hu Xue

doi:10.1371/journal.pone.0331753

Peer Review History

Original SubmissionJanuary 17, 2025
6 Aug 2025 Decision Letter - Ramesh Athe, Editor Dear Dr. Xue, 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 Sep 20 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 you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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, Ramesh Athe, 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. During your revisions, please note that a simple title correction is required: Please include the term "Scoping review" in the title. Please ensure this is updated in the manuscript file and the online submission information. 3. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A 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: No Reviewer #2: Yes ****** Reviewer #1: Thank you very much for entrusting me with reviewing the article. The subject of the study is very valuable. The main problem with this article is the methodology used. As you know, meta-synthesis and meta-analysis are very different in nature, and the procedures and methods are different. In principle, using a registration protocol in PROSPERO is suitable for systematic reviews and meta-analyses, and is not recommended for meta-synthesis studies Nolbit :meta ethnography critical interpretive synthesis framework synthesis are the most common approaches for meta synthesis . And every one of them has different steps . Reviewer #2: The publication is sound and logically organized, written with standard academic English. The data analysis was clearly spelt out at the data analysis part of the paper and the findings explicitly annotated. Overall, the paper is excellent with no obvious breach of research ethic ****** 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: Yes: OBED AIDOO ******** [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.0331753.r001
Revision 1
19 Aug 2025 Author Response Response to Reviewers Dear Editor and Reviewers: Greetings! First of all, on behalf of all the authors, please allow me to extend our sincerest thanks to you and the reviewers. We would like to thank you for taking the time out of your busy schedules to review our paper in detail and provide valuable comments and suggestions. We are fully aware of the importance of these comments in improving the quality of the paper and ensuring academic rigor. After receiving the review comments, we immediately organized our team to conduct in-depth discussion and analysis, and revised and improved the paper in strict accordance with the reviewers' suggestions. Editorial comments are listed below in red font. Reviewer comments are in blue font, such as below, where specific questions are numbered. Our responses are given in black font. The following are our responses and explanations to the reviewers' comments: Editorial comment� 1.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for �le naming: In order to comply with the strict formatting requirements of PLOS ONE, we have revised the formatting of the previous manuscript, which now conforms to PLOS ONE style, as described under "Revised Manuscript with Track Changes" and "Manuscript." 2.During your revisions, please note that a simple title correction is required: Please include the term "Scoping review" in the title. Please ensure this is updated in the manuscript file and the online submission information. Thank you for your meticulous review of our manuscript and your valuable suggestions. However, we found that the title of the manuscript was different from that of the information submitted online. We made corrections to this, and ensure this is updated in the manuscript file and the online submission information. Regarding your suggestion to include the term "Scoping review" in the title, we have carefully considered it and held an internal team discussion. After careful evaluation, we believe that the current topic "Medication Self-Management Experiences of Elderly Patient with Multiple Chronic conditon: "A qualitative meta-synthesis" can most accurately reflect the core content and innovation points of this study for the following reasons: Firstly, Meta-synthesis aims to integrate qualitative research data to generate new theories or in-depth explanations that explain the meaning, experience or social processes behind phenomena, and it needs to answer clear qualitative research questions. A "Scoping review" involves a standardized and systematic search and screening of literature, integrating existing knowledge on a certain topic to determine the main concepts, theories, sources, research types, and knowledge gaps of that topic. It does not require answering specific questions. However,this study aims to comprehensively collect qualitative studies related to the experience of medication self-management in elderly patients with multiple chronic diseases, further analyze and summarize the results of the qualitative studies, and deeply analyze the experience of medication self-management in elderly patients with multiple chronic diseases, so as to provide a reference basis for the development of relevant nursing strategies by clinical workers. Therefore, the phrase "A qualitative meta-synthesis" used in the title is more suitable to be the keyword used in this researce and can effectively assist readers in retrieval. Secondly, the current title is strictly consistent with the methodology section in the manuscript. We have checked the title structures of two similar studies (such as Jarden RJ, Cherry K, Sparham E, et al. Inpatients' experiences of falls: A qualitative meta-synthesis. J Adv Nurs. 2025;81(1):4-19. doi:10.1111/jan.16244; Wang Z, Shi Q, Zeng Y, Li Y. Experiences and perceptions of self-management in people with prediabetes: A qualitative meta-synthesis. J Clin Nurs. 2023;32(17-18):5886-5903. doi:10.1111/jocn.16713), and the current format conforms to the field conventions. We fully understand your revision suggestions for enhancing the visibility of the manuscript, which has been of great help to us. We also respect your and the journal's professional decisions. If further adjustments are needed, please let us know at any time. 3.If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Thank you very much for your valuable comment. The reviewers did not ask us to cite specific previously published works, so we did not quote the relevant literature of the reviewers in the manuscript. Reviewer 1: Regarding Reviewer 1's comments, we are very grateful to the reviewer for taking the time to read our paper. We would like to thank you for your professional review work, constructive comments, and valuable suggestions on our manuscript. Your time and efforts are greatly appreciated. We have revised the manuscript according to your comments as listed in detail below. 1. Thank you very much for entrusting me with reviewing the article. The subject of the study is very valuable. The main problemwith this article is the methodology used. As you know, meta-synthesis and meta-analysis are very different in nature, and the procedures and methods are different. In principle, using a registration protocol in PROSPERO is suitable for systematic reviews and meta-analyses, and is not recommended for meta-synthesis studies. Nolbit: meta ethnography,critical interpretive synthesis framework synthesis are the most common approaches for meta synthesis. And every one of them has different steps. We sincerely thank the reviewers for their expertise in qualitative methods and your valuable insights into the comprehensive plan. Your comment helped us clarify the methodological nuances.We have incorporated explanations based on your recommendations to enhance clarity, and the modified content is as follows: �1�Regarding PROSPERO registration: We acknowledge that PROSPERO is traditionally associated with systematic reviews of quantitative studies.However, after reviewing relevant literature, we found that in recent years, the official Cochrane guidelines have explicitly supported the registration of qualitative synthetic studies in PROSPERO to ensure the transparency of the methods [.Noyes J, Booth A, Cargo M, Flemming K, Garside R, Hannes K, Harden A, Harris J, Lewin S, Pantoja T, Thomas J. Cochrane Qualitative and Implementation Methods Group guidance series-paper 1: introduction. J Clin Epidemiol. 2018 May;97:35-38.doi: 10.1016/j.jclinepi.2017.09.025.], and PROSPERO now accepts registrations for qualitative evidence syntheses (QES), including meta-synthesis and meta-ethnography [PROSPERO (2023) Inclusion of qualitative evidence syntheses (QES) in PROSPERO.National Institute for Health Research (NIHR)]. In addition, our registration focus is on documenting: ① Search strategies and inclusion criteria (to avoid selection bias); ② Analytical framework (Noblit's meta-ethnography); ③ Ethical considerations of interpretive synthesis. Registration in compliance with the qualitative evidence synthesis in PROSPERO (2)On methodology specification: We sincerely thank the reviewers for their profound insights into our comprehensive research methods. Based on the suggestions, we conducted a rigorous examination of the methodology and found that there were indeed significant problems. Subsequently, the research team held a discussion and decided to revise the methodology section to be fully consistent with the meta-ethnographic framework of Noblit & Hare (1988)�For specific revisions, please refer to the methodology section on pages 5 to 8 of the manuscript. We thank the reviewer for pushing us to elevate methodological rigor. These revisions will strengthen the manuscript's scholarly contribution. Reviewer 2: Regarding Reviewer 2's comments, we are very grateful to the reviewer for taking the time to read our paper, and it is an honor to receive Reviewer 2's recognition and praise of our paper. In addition, our careful reading of Reviewer 2's comments does not appear to suggest any changes, and no attachments were found in the emails or manuscript recordsso we have not revised Reviewer 2's comments. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0331753.r002
21 Aug 2025 Decision Letter - Ramesh Athe, Editor Medication Multiple Experiences of Elderly Patient with Multiple Chronic condition: A qualitative meta-synthesis PONE-D-25-02450R1 Dear Dr. Xue, 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. For questions related to billing, please contact billing support . 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, Ramesh Athe, PhD Academic Editor Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0331753.r003
Formally Accepted
Acceptance Letter - Ramesh Athe, Editor PONE-D-25-02450R1 PLOS ONE Dear Dr. Xue, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Ramesh Athe Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0331753.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .