Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Round 1

Reviewer 1 Report

The paper under review reports data relating to the PALCOM scale on the need of palliative care in advanced cancer patients according to their level of complexity and instability, identified thanks to the instrument being studied. According to the authors, the PALCOM scale should facilitate supportive planning, decision making and a rational use of healthcare resources focused on the essential needs of patients; it also seems to have a high predictive value for mortality in the short and medium term. The authors  presented conclusions that are consistent with the hypothesis under study and all the references are appropriate.

Author Response

Dear reviewer.

Thank you very much for your review and comments, which give us confidence in the submission of the manuscript. 

Yours sincerly

Reviewer 2 Report

Thank you for allowing this review to be carried out. This is a high quality document prepared with consistent results. Care should be taken with the data presented because it is a continuation of a previous study and this may confuse the reader.

I think this aspect should become clearer throughout the study. Also when the study wants to be published in the same journal.

To do this, I suggest emphasizing this aspect at the end of the introduction in the hypothesis and in the objective, also in the methodology. Likewise, I suggest changing the title and putting it in relation to the first study with the label part 2.

Author Response

Dear reviewer.

Thank you very much for your review and comments.

I agree that it is appropriate to add information explaining that the study we are now presenting is the second part of the primary validation study of the PALCOM scale. Following your recommendations, we have added the following information to the manuscript:

1) We add "part two" to the title.

2) We add the follow sentence in intruduction (lines 127-134): "The external validation of the PALCOM scale, published in 2023, which confirmed the accuracy of the tool, was the first part of this research project.⁴⁶ In the development³¹ and validation⁴⁶ cohorts of the PALCOM scale, the variables that discriminate the level of complexity at the patient's initial visit were identified, but the evolutionary behaviour of the model during follow-up was not analysed. We now present the second part of this research, which describes the evolutionary behaviour of the complexity of palliative care needs."

3) We add the follow sentence in teh method (lines 152-155): "Part one of this project was the external validation of the PALCOM scale⁴⁶, and part two, which we now present, is the pooled analysis of the development and validation cohorts and also the analysis of the evolutionary behaviour of palliative complexity during patient follow-up."

Thank you again for your comments, which we are sure will improve our work. 
 

Yours sincerely.