Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments
Round 1
Reviewer 1 Report
my recommendation is to accept this work
Author Response
Dear reviewer 1
Thank you for your review of my paper.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Appreciate the authors undertaking this retrospective evaluation of the STAS-J and IPOS-J.
The main takeaway I had from the article was that the IPOS-J was essentially non-inferior to the STAS-J. What was not clear to me was whether there was superiority in any way which would merit transition from the established STAS-J tool. The authors cite that "IPOS-J assesses three dimensions of psychiatric symptoms", but it is unclear whether there is a superior patient outcome as compared to the single dimension of the STAS-J.
Additionally, the "family anxiety," and "communication between medical professionals" was excluded from analysis... what is the importance of these items as compared to the potential gain from the IPOS-J?
A potential option if the author can engage the clinician is to get an assessment of perceived value, ease, etc of the IPOS-J vs. the STAS-J tool.
Otherwise, additional patient outcomes data would be needed or a prospective study to assess whether IPOS-J is superior to the STAS-J in order to merit switching tools.
Author Response
Dear reviewer 2,
Thank you for your valuable review of my paper.
I have revised the paper according to the reviewers’ comments.
The changes are underlined and shown in red.
Below are the point-by-point responses to each comment.
To the reviewer2
#1．What was not clear to me was whether there was superiority in any way which would merit transition from the established STAS-J tool. The authors cite that "IPOS-J assesses three dimensions of psychiatric symptoms", but it is unclear whether there is a superior patient outcome as compared to the single dimension of the STAS-J. Additionally, the "family anxiety," and "communication between medical professionals" was excluded from analysis... what is the importance of these items as compared to the potential gain from the IPOS-J?
→ Thank you for your important remarks. I have revised the description in the first paragraph of Discussion.
Three patients with "intervention required (2)" according to the STAS-J but "intervention not required (0-1)" according to the IPOS-J score were at risk of missing the opportunity for an intervention. The overall agreement rate of "no intervention/need intervention/urgent intervention" was 97.3%, and the rate of intervention and urgent intervention required were comparable between the scores. It is necessary to take into consideration that there are no items in the IPOS-J that correspond to the two items of the STAS-J, "family anxiety" and "communication between medical professionals”. On the other hand, the IPOS-J assesses three dimensions of psychiatric symptoms (anxiety, depressive feeling, and calmness); in contrast, the STAS-J assesses only one (anxiety) such dimension. The IPOS-J examines psychiatric symptoms from several perspectives, and it may be more clinically useful than the STAS-J. Considering these factors, the IPOS-J was considered as clinically useful as the STAS-J when used as a substitute of the STAS-J.
#2．A potential option if the author can engage the clinician is to get an assessment of perceived value, ease, etc of the IPOS-J vs. the STAS-J tool. Otherwise, additional patient outcomes data would be needed or a prospective study to assess whether IPOS-J is superior to the STAS-J in order to merit switching tools.
→I think this is an important point for the dissemination of IPOS-J. I have added the following sentence to the last part of the Discussion.
We believe that these observations need to be verified in the future through prospective intervention studies.
Author Response File: Author Response.docx
Reviewer 3 Report
Abstract
The abstract describes an updated outcome scale (IPOS) which combines “patient assessment” and “peer evaluation”. It would be helpful to define PRO. The abstract is difficult to read as it discusses interventions, and then also the period when intervention stops, as been some of the outcomes measured, it seems to me. It seems the older assessment tool, STAS, is equivalent to the newer hybdrid tool – IPOS.
Introduction
There is background given to the STAS which relies on peer assessment, and has been adopted for Japanese use (STAS-J). Further description of the newer tool, IPOS, is provided.
The study questions included:
A Japanese version of the IPOS (IPOS-J) was published in 2019 [20]. We have decided 52 to propose the following questions in anticipation of a future transition from the STAS-J: 53
(1) Can an evaluation by the IPOS-J performed by medical professionals (peer evalu-54 ation) replace that by the STAS-J? 55
(2) Can the quality of palliative care improve by combining the IPOS-J patient evalu-56 ation, which is a PRO evaluation, with the peer evaluation? 57
The overall aim of this study was to explore the potential applicability of the IPOS-J 58 (provisional version) to clinical practice.
The study sets out to compare the scores provided by STAS-J and IPOS, and also what interventions were required for the patients. There is also an element of determining the impact of patient input into these scores.
Appropriate statistical analysis was used.
Results
Generally the IPOS-J and STAS-J provided similar results in terms of “no intervention required”, “intervention required” and “immediate intervention required”.
Discussion
It appears that the IPOS-J and STAS-J are equivalent in terms of assessments by medical professionals. The IPOS-J provided more information in terms of psychiatric symptoms (in addition to anxiety, also depressive feeling and calmness).
There was also discussion on the contribution of patient evaluation. It appears that health professionals may assess higher than patients their provision of information, and there capability to assist the social context of the patient.
It was not clear how these assessments assist with transition from cancer treatment to palliative care, in the context of “early palliative care” and “integration of oncology and palliative care”
Conclusion
The conclusion is brief. Perhaps specific similarities between IPOS-J and STAS-J could be given, as well as the benefits of IPOS-J.
What do the authors mean by institutional approval to pefrom the clinical practice.
Author Response
Dear reviewer 3,
Thank you for your valuable review of my paper.
I have revised the paper according to the reviewers’ comments.
The changes are underlined and shown in red.
Below are the point-by-point responses to each comment.
To the reviewer3
#1. Abstract: It would be helpful to define PRO.
→ According to the reviewer’s comment, I added a description of the contents of the PRO in the Abstract.
#2. Discussion: It was not clear how these assessments assist with transition from cancer treatment to palliative care, in the context of “early palliative care” and “integration of oncology and palliative care”
→ In accordance with the reviewer's comment, I have revised the description of the relevant part of the Discussion.
In this context, we expect that the IPOS-J, a hybrid assessment tool, will enable us to provide high-quality palliative care at an earlier stage of cancer treatment and to support the transition from cancer treatment to palliative care at an appropriate time with respect for the patient's wishes and with enhanced social support.
#3. Conclusion: The conclusion is brief. Perhaps specific similarities between IPOS-J and STAS-J could be given, as well as the benefits of IPOS-J.
→ According to the reviewer's comment, I described it in more detail.
Therefore, it was deemed appropriate to replace the STAS-J with the IPOS-J. Furthermore, by adding patient evaluation　(PRO) to peer evaluation and emphasizing "listening to the patient's voice," it will be possible to further understand the problems that patients face and to more accurately assess the extent of these problems. Appropriate intervention based on this will enable the provision of higher quality palliative care. It is important to verify these observations through prospective studies and to promote the widespread use of this tool.
#4. What do the authors mean by institutional approval to pefrom the clinical practice.
→ At the time this study was conducted, IRB approval was not required for retrospective studies in Japan.
By the way, the IPOS used in this study was not yet in widespread use in Japan, so we obtained institutional approval to use it as one of the evaluation tools and used it in our daily clinical practice.
Author Response File: Author Response.docx
