Interprofessional collaboration between hospital-based palliative care teams and hospital ward staff: A realist review

Louana Moons; Fouke Ombelet; Mieke Deschodt; Maaike L. De Roo; Eva Oldenburger; Inge Bossuyt; Peter Pype

doi:10.1371/journal.pone.0338132

Peer Review History

Original SubmissionMay 8, 2025
3 Oct 2025 Decision Letter - Suyan Tian, Editor Dear Dr. Deschodt, 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 Nov 17 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'. 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Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: This is a well executed realist evaluation of palliative care team interaction with ward staff. Over all this was interesting to read and made some good recommendations. The CMOs are nuanced and were supported extremely well by the figures and diagrams in the Supplementary files. Interesting choice of initial program theory but it works quite well. Introduction More information about how the palliative care team supports the ward team should be given here. I thought initially they took over full care of the patient. A few extra sentences giving an example of a scenario where the PCT operated as intended would be helpful for readers like me who have not worked in a hospital for many years. Whose call is it to bring in the PC team? What happens? Do they keep monitoring them? How many people in the PC team? Methods Can you include some information about the team, elaborating on what expertise and experience was represented? Results I liked that you identified the prerequisites for collaboration, rather than trying to shoehorn them into the CMOs. The Supplementary files are very useful. Discussion Line 501ff “To foster double-loop learning, …. By implementing such changes, interprofessional collaboration (IPC) could be improved, and ward staff would no longer feel burdened by time constraints.” Not sure this suggestion makes sense. Seems to increase the work of the ward staff rather than lessen it. Can you reconsider this paragraph? Maybe I have misunderstood and it needs clarifying. Can you add a comment about other IPC based on this. Perhaps some elements could apply for other specialist teams? If not, can you spell out why PCT interactions are different. Justa sentence or two would do it but I was curious to see what you think. Figure 2 is very helpful and certainly conveys the complexity of the moving parts. A few typos or minor grammar issues Line 89: “… as a considerate number of papers” should be “considerable” Line 114: “…for a mechanism to get triggered” should be “for a mechanism to be triggered.” Line 175: “(physicians, nurses, social 9 176 workers…).” Better to say (e.g., physicians, nurses, social workers) Line 255: “non-judgement approach” should be non-judgemental ****** 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: Janet C Long ******** [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.0338132.r001
Revision 1
24 Oct 2025 Author Response Journal 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 https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Thank you for bringing this to our attention. We have adjusted necessary style requirements, including those for file naming and text styles. 2. 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. The reviewers’ comments did not include a recommendation to cite specific previously published works. Hence, our reference list remained unadjusted. Editor Comments: None. Reviewers’ comments: Reviewer #1: In general: This is a well executed realist evaluation of palliative care team interaction with ward staff. Over all this was interesting to read and made some good recommendations. The CMOs are nuanced and were supported extremely well by the figures and diagrams in the Supplementary files. Interesting choice of initial program theory but it works quite well. Dear reviewer, thank you for taking the time to review our manuscript. We appreciate your positive feedback and are pleased you found the manuscript satisfactory. Thank you for your considerate questions and suggestions. Please find below some clarifications and adjustments we have carried out based on your feedback. Introduction: More information about how the palliative care team supports the ward team should be given here. I thought initially they took over full care of the patient. A few extra sentences giving an example of a scenario where the PCT operated as intended would be helpful for readers like me who have not worked in a hospital for many years. Whose call is it to bring in the PC team? What happens? Do they keep monitoring them? How many people in the PC team? Thank you very much for your thoughtful comment. We have revised the introduction to include additional detail on the composition of PCTs and added a brief example to clarify their consultative role. While PCTs typically support ward teams rather than assume full responsibility for patient care, their structure and involvement vary considerably across countries and institutions. As such, questions like “Whose call is it?” or “Do they continue monitoring?” are difficult to generalize and were not fully addressed in the introduction. Our primary aim with this paragraph was to emphasize the importance of interprofessional collaboration between PCTs and ward staff, which is central to our study. Page 4, lines 60 – 66: “PCTs are multidisciplinary, often including physicians, nurses and psychologist. Rather than taking over primary patient care, PCTs provide consultative support and advise to hospital ward staff regarding palliative care. For example, in a case of a patient with advanced cancer and escalating symptoms, the PCT might support hospital ward staff in advance care planning conversations, adjusting medication prescription, and coordinating family support, while hospital ward staff remains responsible for daily care delivery. This underscores the importance of effective interprofessional collaboration (IPC) to ensure optimal PC delivery [9].” Methods: Can you include some information about the team, elaborating on what expertise and experience was represented? We have added a description of the research team to clarify the range of expertise represented, including clinical experience in palliative care, as well as academic expertise in implementation science, palliative care research, realist review methodology, and interprofessional collaboration. Page 5, lines 88 – 91: “The research team included academic experts in implementation science (MD), nursing research (LM), palliative care research (MDR), and realist review methodology and interprofessional collaboration (PP) as well as clinical experts in palliative care (EO, IB).” Results: I liked that you identified the prerequisites for collaboration, rather than trying to shoehorn them into the CMOs. The Supplementary files are very useful. Thank you for this positive feedback. Discussion: Line 501ff “To foster double-loop learning, …. By implementing such changes, interprofessional collaboration (IPC) could be improved, and ward staff would no longer feel burdened by time constraints.” Not sure this suggestion makes sense. Seems to increase the work of the ward staff rather than lessen it. Can you reconsider this paragraph? Maybe I have misunderstood and it needs clarifying. Can you add a comment about other IPC based on this. Perhaps some elements could apply for other specialist teams? If not, can you spell out why PCT interactions are different. Just a sentence or two would do it but I was curious to see what you think. Figure 2 is very helpful and certainly conveys the complexity of the moving parts. Thank you for your thoughtful comment. We agree that the original paragraph may have unintentionally implied an increased workload for ward staff. We’ve revised the section to clarify that perceived time constraints might stem from limited PC confidence rather than actual task volume. The revised paragraph now emphasizes double-loop learning as a systemic solution to reduce this sense of overwhelm. We believe that by integrating structural changes like provision of in-hospital PC training, double-loop learning could be achieved. In our opinion, this approach could empower ward staff in their generalist PC knowledge and skills, making them feel more comfortable in providing PC and feeling less overwhelmed or constrained by time, without adding to their burden. Page 22, lines 508 – 516: “Friction also arises when staff is confronted with a patient’s worsening clinical status but are constrained by lack of time. However, this perceived time pressure may be rooted in limited PC knowledge, leaving ward staff to feel overwhelmed, causing them to ask support from their PCT—a response characteristic of single-loop learning. To foster double-loop learning, hospitals should address these underlying causes of experiencing lack of time due to limited PC knowledge by investing in systemic solutions, for example a yearly PC training for ward staff. Such initiatives can gradually shift norms within the system and increase comfort with PC tasks among ward staff, reducing the sense of being overwhelmed even if the workload remains unchanged. While this approach may initially require additional effort, it can enhance efficiency and interprofessional collaboration (IPC) in the long term.” A few typos or minor grammar issues: - Line 89: “… as a considerate number of papers” should be “considerable” - Line 114: “…for a mechanism to get triggered” should be “for a mechanism to be triggered.” - Line 175: “(physicians, nurses, social 9 176 workers…).” Better to say (e.g., physicians, nurses, social workers) - Line 255: “non-judgement approach” should be non-judgemental Thank you for bringing these to our attention. We have adjusted the typos and minor grammar issues based on your feedback. In addition, I also adjusted some typos at lines 301 and 302. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0338132.r002
18 Nov 2025 Decision Letter - Suyan Tian, Editor Interprofessional collaboration between hospital-based palliative care teams and hospital ward staff: a realist review PONE-D-25-22843R1 Dear Dr. Deschodt, 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, Suyan Tian 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 ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: Thank you for your thoughtful responses. This is an excellent paper and I look forward to seeing it in print. ****** 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: Janet C Long ******** https://doi.org/10.1371/journal.pone.0338132.r003
Formally Accepted
Acceptance Letter - Suyan Tian, Editor PONE-D-25-22843R1 PLOS One Dear Dr. Deschodt, 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. Suyan Tian Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0338132.r004

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