Shared-Care in Complex Malignant Hematology: An Integrative Review Using the RE-AIM Evaluation Framework

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overall, this is a very well-conceptualized and well-presented systematic review of shared care models for patients with rare and complex cancers. I very much appreciated the use of the RE-AIM model to organize the review and presentation. The authors were clear about the limits of this work....The study does offer a clear road-map/recipe for conducting definitive studies in this area.

Three small suggestions:

1) The RE-AIM framework is just one of several program planning and implementation models. The authors could add or two sentences about why they chose this framework vs others.

2) The initials/abbreviation "APL" are used in describing one study....I did not know what this referenced.

3) throughout the results but especially in the discussion, the paper notes the  percentage of programs/studies for which each set of information was available or for other comparisons. Such percentages are just not meaningful and potentially misleading when examining 8 projects....elsewhere you say "2/8" etc to reflect the distributions of response. I would recommend using this later approach throughout the paper and eschew the potentially misleading percentages. 

Author Response

Overall, this is a very well-conceptualized and well-presented systematic review of shared care models for patients with rare and complex cancers. I very much appreciated the use of the RE-AIM model to organize the review and presentation. The authors were clear about the limits of this work....The study does offer a clear road-map/recipe for conducting definitive studies in this area.

Three small suggestions:

• The RE-AIM framework is just one of several program planning and implementation models. The authors could add or two sentences about why they chose this framework vs others.

Response: Thank you for your comments. The paper has been updated to include 2 sentences to describe the rationale for choosing the RE-AIM framework (see lines 70-75).

• The initials/abbreviation "APL" are used in describing one study....I did not know what this referenced.

Response: The abbreviation of APL has been used within table 3, and the full title of acute promyelocytic leukemia has been included in the footnote. Additionally, the abbreviation of AML was used twice within the written portion of the paper and has been updated as well (see lines 182 and 323).

• throughout the results but especially in the discussion, the paper notes the percentage of programs/studies for which each set of information was available or for other comparisons. Such percentages are just not meaningful and potentially misleading when examining 8 projects....elsewhere you say "2/8" etc to reflect the distributions of response. I would recommend using this later approach throughout the paper and eschew the potentially misleading percentages. 

Response: Thank you for your comment. You make a good point that percentages are not as useful with a small sample of 8 programs, thus the results section has been modified to exclude the %.

As for the discussion, the percentages reported are reflective of the proportion of programs reporting on RE-AIM dimensions (Reach, Effectiveness Etc.) as well as the indicators. (See Table 4). This may have come across unclear, thus we have made some changes: line 140- added indicators; table 4- added indicators to the title and heading; line 22, 25, 288 and 293- this previously read as ‘details of reach’ and ‘details of adoption’, thus to be consistent and make it clear to the reader, these were changed to indicators.

Reviewer 2 Report

Comments and Suggestions for Authors

The main question addressed by the research was to examined what is known about CMH shared-care using the RE-AIM evaluation framework.

What I consider relevant of this review for the field is the possible options that patients could have close to home if these shared-care methods are reliable. This adds a major scope and opportunities to those patients that have difficulties moving from their home into specialized academia facilities to get treated and mitigate the costs on the long run. It would be interesting to add controls or a possible study that includes virtual care as our world specially in the medical field has adapted many practices to provide virtual care as an option.The conclusions are consistent with the review as pointed the emphasis made on the review and also highlighted the importance of other areas that would be interesting to cover in a future review. References are appropriate and in scope of this review.

Author Response

The main question addressed by the research was to examined what is known about CMH shared-care using the RE-AIM evaluation framework. What I consider relevant of this review for the field is the possible options that patients could have close to home if these shared-care methods are reliable. This adds a major scope and opportunities to those patients that have difficulties moving from their home into specialized academia facilities to get treated and mitigate the costs on the long run. It would be interesting to add controls or a possible study that includes virtual care as our world specially in the medical field has adapted many practices to provide virtual care as an option. The conclusions are consistent with the review as pointed the emphasis made on the review and also highlighted the importance of other areas that would be interesting to cover in a future review. References are appropriate and in scope of this review.

 

Response: Thank you for your thoughtful comments, particularly regarding virtual care. In our discussion, we also highlighted the need for research on how virtual care can expand opportunities for shared-care.

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

This is an excellent review paper and will get frequent citations and uses in educational settings as an example of using a conceptual framework in conducting a review to yeild new insights and important new directions for practice and research. The paper also offers a balanced and nuanced perspective on the shared care model despite finding only a small number of prior papers.