Higher and Middle Management Perspectives on Patient-Centered Care in an Oncology Setting: A Qualitative Study
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
The article is interesting to read. The topic of the article is very relevant.
The main question addressed by the research: What are the key challenges of patient-centered care (PCC) in oncology settings from the hospital employee point of view. The topic is very relevant to the field of psycho-oncology. The qualitative approach to collect data allows to comprehensively assess the perceptions of the middle and higher managers of PCC and address a specific gap in the field. Until now, no studies have been conducted to evaluate RCC in oncology settings based on hospital employee perceptions.
Methodology is appropriate for this study. In the future, this study could be complemented by a quantitative study.
In general, the conclusions are consistent with the evidence and arguments presented. In order to improve the quality of the article, I would suggest that the authors shorten the conclusions, especially the first paragraph in the Conclusions section.
The references are appropriate.
The article contains one table Main themes and subthemes. There are no comments for the table.
Author Response
comment 1 (I would suggest that the authors shorten the conclusions, especially the first paragraph in the Conclusions section.)
response 1 ( Thank you for your valuable feedback.
- I tend to shorten the conclusion and omit a summary of the results in that section.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
The Topic discussed in this manuscrpt is relevant and timely especially among cancer communities.
• The paper addressed higher and middle management perspectives and understanding of PCC in Oncology
• The topic is timely and relevant considering Oncology patient in most setting is from low- and middle-income groups.
• The paper does address gaps as the PCC have only been given attention now as mostly patients were reliant on HCP decision regarding treatment plan, as their perception of PCC can inform patient outcomes
• The perspectives and knowledge and understanding of HCP is necessary in order to guide patient outcomes and improve patients’ perception and their involvement t in care decision making.
The Methodology:
The methods is quiet sound and well discussed and followed with well supported discussion.
• Choosing a qualitative face-face interview is relevant as it gave participants a voice to reflect on their perceptions of PCC
• The participants demonstrated the importance of including PCC care to improve patient outcomes and give them a voice in care decisions regarding their illness
• The conclusions derived based on the literature and themes emerging are relevant and detailed explanation provided to demonstrate relevance in the field.
The Recommendations:
Recommendations to have educational programs to empower patients to be self-reliant to choose treatment and involve culturally relevant aspects and uphold their values and pursue their values demonstrate the caring ethic,
As stated in the discussion it is crucial that further engagements in educational programs be encouraged to enhance patients understanding and their role as beneficiaries in PCC and the families.
Minor comments for English language edit. The are minor corrections for Engilsh language see line 258 & 267 ( defiantly ) I suppose it is meant to read ""definate". Line 298 supposed to read "proper"
Recommend publishing as the paper contributes to this subject and provide more insight in oncology setting
Contributions:
• The paper demonstrated the relevance of PCC and managers insights with regard to PCC.
• Existing gaps on patients’ reliance on HCP regarding involvement on care decisions have been highlighted
• Existing gaps on patient education on matters regarding their involvement in PCC has been highlighted
References cited are relevat to back the discussion. Well written paper.
Comments on the Quality of English Language
English langauge profiency good. Picked up minor editorial issue on three lines indicated.
Author Response
comment1 (Minor comments for English language edit. They are minor corrections for English language see line 258 & 267 ( defiantly ) I suppose it is meant to read ""definate". Line 298 supposed to read "proper")
response 1( Thank you for your valuable feedback.)
It was corrected.
comment 2 ( recommendation part)
response 2 ( recommendation section was added to the manuscript)
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
This is a paper about a relevant topic due to the recognised importance of patient centred care for those diagnosed with, living with or beyond cancer. Key issues to address include some rewriting to improve clarity, adding more information to the methods section (reflecting a bit further on the identified themes), and revising the discussion and conclusion sections, focusing on avoiding repetition and outlining implications of results, and recommendations for future research. These issues are outlined below.
Major issues
1. There are several sentences which are not fully clear, and some of the words used seem a bit out of place. I have highlighted some of these issues below (individually, they are minor issues, but as a group they become a major issue). I would recommend thoroughly proofreading the paper.
2. Title: Perhaps “settings” instead of “setting”? It is worth clarifying this issue as it is not fully clear if participants are from one or more than one setting. The methods section (Participant and setting) indicates that all participants worked at an “international cancer care center”, but elsewhere in the paper there are references to oncology settings.
3. Introduction, first paragraph: This paragraph uses quite informal language (almost like a lay summary), and references are missing. Consider rewriting this so the style matches the rest of the paper.
4. Introduction, fourth paragraph, first sentence – please add a few references to corroborate this statement.
5. Introduction, fourth paragraph: Here it is stated that it is vital to evaluate the degree PCC principles are implemented, and this can be done by investigating providers’ views on PCC. However, it does not look like implementation was evaluated, although views on barriers (which could be hypothetical or real) were presented. Consider rewriting this sentence, focusing more on perspectives and less on evaluating implementation.
6. Introduction, sixth paragraph. This paragraph seems to contradict the previous one, where an example is given of a previous study with middle managers in a hospital setting.
7. Methods, Participant and setting: please clarify what kind of purposive sampling was carried out (what was the team trying to achieve? A mix of age? Expertise?). How were managers contacted? By whom? How many different settings (one or more)? Were the participants based in Jordan, Oman or both countries?
8. Methods, Data collection: The first sentence indicates that a PhD student carried out the interviews. However, in line 127 it is stated that all the interviews were conducted by the same investigators. Was there more than one interviewer?
9. Methods, data collection, line 128: Were transcriptions checked for accuracy?
10. Methods, data analysis: Pease add who coded the data, and how many researchers were involved.
11. Results (overall): At times it is difficult to link the findings under the theme to the theme itself, e.g. it is not clear the role of leadership in spreading awareness, or opening discussions. I understand that managers were interviewed, and they are by definition leaders, but it is not clear that they linked their leadership role with the issues mentioned here. Consider adding quotes that make this link clearer.
12. Results, Themes subsection: Please ensure that the themes in the paragraph match what is in Table 1 (furthermore, text has five themes, while table 1 has six), preferably in the same order to facilitate reading and understanding.
13. Results (overall): Some of the themes are quite broad, and awareness seems to be a recurring theme across most of the themes. Consider adding a supplementary table defining each theme/subtheme.
14. Discussion (overall): There is quite a bit of repetition here, reiterating all themes. While there are several references to other studies, there is less about the implication of the results regarding practice, and also the relevance of the findings to the health care context in Jordan and Oman. More reflection on what this study adds to the literature would also strengthen the manuscript.
15. Discussion section, first paragraph: As before, please ensure that theme names match throughout the manuscript.
16. Conclusion section (overall): This section repeats quite a lot of what has been said before, but there is very little in terms of implications or “what next?” Consider rewriting this section.
Minor issues:
Introduction, third paragraph, line 51: The first sentence could benefit from editing for clarity. What is meant by “health care delivery mood”? Did the authors mean “mode”?
Introduction, third paragraph, line 56: “a part” instead of “a apart”?
Introduction, fourth paragraph, lines 58-59: What is meant by “this is obvious by integrating”? Perhaps replace the word “obvious” with “done” or another similar word?
Introduction, fifth paragraph. Consider rewriting the first two sentences as there is a bit of repetition. Consider removing “In which” from the beginning of the third sentence. In line 72, “While the” can possibly be removed
Introduction, sixth paragraph. Consider replacing “up to the author knowledge” with “to the authors’ knowledge”.
Methods, Participant and setting: future tense is being used here – since the study has finished and recruitment is no longer taking place, consider rewriting the last sentence.
Methods, Ethical consideration: The word “is” (line 97) can be removed. “In” instead of “in” in line 99? Line 101: Which author? Consider adding an initial
Results section, line 155: please note typo for word “involved”
Results section, line 157: Please remove the duplicate “with an”. Full-stop is missing in line 160.
Theme 2 subheading, line 188 – Spacing is missing between “Theme” and “2”. Also consider clarifying the first sentence in this subsection (lines 189-190). What is meant by “key elements”? Key elements to support PCC?
Results (overall): There is no need to specify how many participants contributed to each theme – as this is a qualitative study, quantity is not that important. Consider giving less emphasis to quantity when reporting the results
Results, theme 3, line 212: “as key elements” instead of “is a key elements”?
Theme 5, line 258: What is meant by “defiantly” in this context? Did the authors mean to say “definitely”?
Theme 5, line 258: Please check punctuation here
Theme 5, line 269: No apostrophe is needed, i.e. it should be managers instead
Comments on the Quality of English Language
Please see comments on the language above. Proofreading is recommended.
Author Response
comment 1 :
There are several sentences which are not fully clear, and some of the words used seem a bit out of place. I have highlighted some of these issues below (individually, they are minor issues, but as a group they become a major issue). I would recommend thoroughly proofreading the paper.
Response 1:
Thank you for your valuable feedback.
Each comment was carefully considered, and your suggestions were addressed appropriately to enhance the quality of this manuscript."
comment 2:
Title: Perhaps “settings” instead of “setting”? It is worth clarifying this issue as it is not fully clear if participants are from one or more than one setting. The methods section (Participant and setting) indicates that all participants worked at an “international cancer care center”, but elsewhere in the paper there are references to oncology settings.
response 2:
Thank you for your valuable feedback.
- This research was conducted in one international oncology center. Each instance of 'settings' in the body of the manuscript was amended to 'setting'
comment 3:
Introduction, first paragraph: This paragraph uses quite informal language (almost like a lay summary), and references are missing. Consider rewriting this so the style matches the rest of the paper.
response 3
I appreciate your guidance in enhancing the clarity and rigor of the manuscript
I have revised the paragraph to adopt a more formal tone and ensure it aligns with the overall style of the paper. Additionally, I have incorporated relevant and updated citations to support the key points discussed. I appreciate your guidance in enhancing the clarity and rigor of the manuscript
comment 4+5:
- Introduction, fourth paragraph, first sentence – please add a few references to corroborate this statement.
Introduction, fourth paragraph: Here it is stated that it is vital to evaluate the degree PCC principles are implemented, and this can be done by investigating providers’ views on PCC. However, it does not look like implementation was evaluated, although views on barriers (which could be hypothetical or real) were presented. Consider rewriting this sentence, focusing more on perspectives and less on evaluating implementation.
response 4+5
Thank you for your valuable feedback.
I have revised the paragraph to clarify the focus on healthcare providers' perceptions of patient-centered care (PCC) rather than evaluating the degree of implementation. Additionally, I have added several references to support the statements made, ensuring a stronger foundation for the claims presented.
comment 6
Introduction, sixth paragraph. This paragraph seems to contradict the previous one, where an example is given of a previous study with middle managers in a hospital setting.
response 6
Thank you for your valuable feedback.
I have revised the second paragraph to specify that while previous studies have indeed assessed PCC perceptions among various hospital staff, including middle managers and nurses, there remains a notable gap in research focused specifically on oncology settings. This clarification emphasizes the need for further investigation into how PCC is perceived within oncology, particularly from the perspectives of middle and higher management.
comment 7
Methods, Participant and setting: please clarify what kind of purposive sampling was carried out (what was the team trying to achieve? A mix of age? Expertise?). How were managers contacted? By whom? How many different settings (one or more)? Were the participants based in Jordan, Oman or both countries?
response 7
Thank you for your valuable feedback.
All the following points have been incorporated and reflected in the manuscript body.
- Purposive Sampling Clarification: We employed a purposive sampling technique aimed at achieving a diverse representation of both age and expertise among the participants. Our goal was to include middle and higher managers with varying years of experience and backgrounds in cancer care management. This diversity was intended to enrich the data collected, ensuring that we captured a broad spectrum of perceptions regarding PCC.
- Participant Recruitment: Participant were contacted through sending them invitation email to participate in the study.
Settings: The study was conducted in both Jordan only.
comment 8
Methods, Data collection: The first sentence indicates that a PhD student carried out the interviews. However, in line 127 it is stated that all the interviews were conducted by the same investigators. Was there more than one interviewer?
response 8
Thank you for your comment.
We would like to clarify that the PhD student mentioned in the first sentence of the Data Collection section is, in fact, the same investigator who conducted all the interviews. There was only one interviewer involved in the data collection process. We have made changes and replace “investigator” with “researcher” to ensure this is clearly stated and avoid any confusion.
comment 9
Methods, data collection, line 128: Were transcriptions checked for accuracy?
response 9
Thank you for your comment.
- To ensure the accuracy of the transcription, the researcher cross-checked a sample of the transcripts against the original audio recordings. Any discrepancies were reviewed and corrected to ensure the transcripts accurately reflected the participants' responses.
This justification was reflected into the manuscript.
comment 10
Methods, data analysis: Please add who coded the data, and how many researchers were involved.
response10
Thank you for your comment.
- The coding of the data was conducted by two researcher. The second author performed the initial coding, and the third research reviewed the codes to ensure accuracy and consistency
This justification was reflected into the manuscript
comment 11
Results (overall): At times it is difficult to link the findings under the theme to the theme itself, e.g. it is not clear the role of leadership in spreading awareness, or opening discussions. I understand that managers were interviewed, and they are by definition leaders, but it is not clear that they linked their leadership role with the issues mentioned here. Consider adding quotes that make this link clearer.
response 11
Thank you for your comment.
- Quotes have been added to the theme # 3
((Moreover, participants addressed that leadership has high impact on spreading the awareness of PCC at different levels, through awareness program, and PCC enculturation. “Oncology leadership, from here we begin, how they feel toward implementing PCC; presence strong vision, support, follow up, and establishing of PCC awareness program and PCC enculturation at level of health care providers, patients, and community, this will lead to be implemented easily. “P01.))
comment 12
Results, Themes subsection: Please ensure that the themes in the paragraph match what is in Table 1 (furthermore, text has five themes, while table 1 has six), preferably in the same order to facilitate reading and understanding.
response 12
Thank you for your comment.
We have carefully reviewed the themes in the paragraph and ensured that the text contains six themes, matching what is presented in Table 1. Additionally, we verified the sequence of the themes in both the text and the table, and no discrepancies or mistakes were found. The themes are presented in the same order to facilitate reading and understanding.
comment 13
Results (overall): Some of the themes are quite broad, and awareness seems to be a recurring theme across most of the themes. Consider adding a supplementary table defining each theme/subtheme.
response13
Thank you for your comment.
- A supplementary table containing the definitions of each theme and sub-theme has been prepared and submitted.
Regarding awareness in Theme #3, this was suggested as the enculturation of the PCC concept for patients, healthcare providers (HCP), and at the community level. In contrast, awareness in Theme #6 refers to strategies to enhance PCC in the oncology setting. While both concepts address similar ideas, one emphasizes leadership efforts, while the other focuses on practical tips for effectively enhancing PCC.
comment14
Discussion (overall): There is quite a bit of repetition here, reiterating all themes? While there are several references to other studies, there is less about the implication of the results regarding practice, and also the relevance of the findings to the health care context in Jordan and Oman. More reflection on what this study adds to the literature would also strengthen the manuscript
response 14
Thank you for your comment.
All the discussion part was refined
comment 15
Discussion section, first paragraph: As before, please ensure that theme names match throughout the manuscript
response 15
Thank you for your comment.
All the discussion part was refined
comment 16
Conclusion section (overall): This section repeats quite a lot of what has been said before, but there is very little in terms of implications or “what next?” Consider rewriting this section
response 16
Thank you for your comment.
The conclusion was refined
comment 17
Introduction, third paragraph, line 51: The first sentence could benefit from editing for clarity. What is meant by “health care delivery mood”? Did the authors mean “mode”?
response 17
Thank you for your comment.
It’s a typo, we replaced “mood” by “model”.
comment 18
- Minor issues:
response 18
All the minor issues were refined and corrected.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for Authors
I believe that the authors have addressed my comments. My only additional feedback is regarding the language/grammar (see below).
Comments on the Quality of English Language
Some minor edits are required. Please check the use of future tense in the methods section, use of singular/plural towards the manuscript, among other issues.
Author Response
comment 1 : Some minor edits are required. Please check the use of future tense in the methods section, use of singular/plural towards the manuscript, among other issues.
Response 1: Thank you very much for your valuable and insightful comment. I have proofread the manuscript, and the changes have been addressed and highlighted in red.
Author Response File: Author Response.pdf
