Patient and Physician Satisfaction with Telemedicine in Cancer Care in Saskatchewan: A Cross-Sectional Study

Round 1

Reviewer 1 Report

General comments:

I wish to thank the editor for inviting me to review the paper titled “Patients and physicians satisfaction with telemedicine in cancer care in Saskatchewan: A cross-sectional study”

The article is interesting to review, and my comments/suggestions are given to improve the manuscript’s quality.

Title:

1. Patients and physicians satisfaction? Kindly consider the apostrophe mark

Introduction:

2. Authors may consider updating the references as numerous references are more than 5-year-old.
3. Interestingly, the authors stated, “On average, patients from rural communities travel two to three hours to access health care not readily available to them close to their home (6)”. Is it in Canada or some other country? The reference is outdated. Kindly consider updating the latest one and changing the introduction accordingly.
4. The research was conducted almost three years before. The authors need to explain more about linking the present study’s findings to the current scenario. Otherwise, this study may carry less value.

Methodology:

5. Did the authors include pediatric patients also (as the manuscript mentioned all patients)?
6. The authors did not explain the sampling method used to select the study participants.
7. The authors used a different number of items in paper vs. electronic format? How did you adjust during the analysis?
8. Is the data collection tool of the present study adopted, or is the authors made? More explanation is required regarding items, validity, reliability etc
9. A six-point Likert score was used for most survey questions. However, the authors did not mention anything about scoring.
10. Logistic regression analysis was performed to assess the correlation between self-reported clinical and social factors and a positive telemedicine experience. However, the authors did not mention anything about grading.
11. The authors mentioned as logistic regression analysis was performed to find the correlation; kindly note that logistic regression analysis is done to identify the predictors. Also, why did the authors apply only univariate analysis, not multivariate analysis?
12. The statistical analysis section needs more explanation.

Results:

13. Table 5 indicates that the authors used open-ended questions also. However, details are missing in the methodology section.
14. Logistic regression analysis results must be presented in Table format.

Discussion:

15. Is it possible for the authors to provide their insight into the advantages and disadvantages of telemedicine and discuss how the healthcare service providers could best combine in-person service and online service to maximize the satisfaction of patients and service quality?  

 

Author Response

May 18, 2022

 

Dr. Sharlene Gill

Editor-in-Chief

Current Oncology                                                                                                                                                                                                 

RE: Patients and physicians’ satisfaction with telemedicine in cancer care in Saskatchewan: A cross-sectional study

Dear Dr. Gill

Thank you very much for your correspondence about the above manuscript submitted for consideration for publication in Current Oncology. We appreciated the comments made by the reviewers and have thoroughly addressed them in the second revision of the manuscript as described below:

Reviewer 1

Title:

1. Patients and physicians satisfaction? Kindly consider the apostrophe mark

 

Thanks for this comment. We have added apostrophe mark in the title.

Introduction:

1. Authors may consider updating the references as numerous references are more than 5-year-old.

 

We have updated the references and have replaced old citations with new citations.

 

1. Interestingly, the authors stated, “On average, patients from rural communities travel two to three hours to access health care not readily available to them close to their home (6)”. Is it in Canada or some other country? The reference is outdated. Kindly consider updating the latest one and changing the introduction accordingly.

 

It is a general statement for rural patients. We have included additional references relevant to travel distance from Canada, USA and Australia that have scatter populations in northern areas.

 

 

 

1. The research was conducted almost three years before. The authors need to explain more about linking the present study’s findings to the current scenario. Otherwise, this study may carry less value.

 

Thanks very much for this comments. This study was performed shortly before the COVID-19 pandemic. The COVID-19 pandemic has changed the delivery of care model in oncology and other specialty and virtual care has been adapted for a wider group of cancer patients regardless of their residence. The current study provides information on telehealth satisfaction in rural cancer patients prior to the pandemic that will be useful to clinicians, researchers, and policy makers.  We have added this information in the introduction section “As the COVID-19 pandemic has altered the model of care in oncology……………………….satisfaction with telemedicine among rural cancer patients during pre-COVID period”.

 

Methodology:

1. Did the authors include pediatric patients also (as the manuscript mentioned all patients)?

 

Only adult patients with cancer were included. It has been specified in the method section.

 

1. The authors did not explain the sampling method used to select the study participants.

 

Thanks very much for this comments. The consecutive sampling method was used. The sampling methods has been specified in the revised manuscript. “Consecutive sampling was used……………………… to participate in the survey”.   

 

1. The authors used a different number of items in paper vs. electronic format? How did you adjust during the analysis?

 

Thank you for this comments. We have performed separate analyses for patients and physicians.

 

 

1. Is the data collection tool of the present study adopted, or is the authors made? More explanation is required regarding items, validity, reliability etc

 

The survey was developed locally by adapting various tele-health satisfaction surveys. It was not validated. It has been clarified in method section (The survey was developed locally ………………………demographic and socio-economic variables”) and in the discussion section (The survey was ………… validated) in the limitations of the study.

 

 

1. A six-point Likert score was used for most survey questions. However, the authors did not mention anything about scoring.

 

The scoring is specified in the method section of the revised paper “A six-point Likert score from 1 to 6 (1=strongly disagree, 6=strongly agree) was used for ………………….an open ended section for comments”.

 

 

1. Logistic regression analysis was performed to assess the correlation between self-reported clinical and social factors and a positive telemedicine experience. However, the authors did not mention anything about grading.

 

We have elaborated the logistic regression in the method section. All variables were categorized into two category as described in the method section. Please see elaboration of logistic regression methodology in the revised manuscript (Track changes) 

 

1. The authors mentioned as logistic regression analysis was performed to find the correlation; kindly note that logistic regression analysis is done to identify the predictors. Also, why did the authors apply only univariate analysis, not multivariate analysis?

 

Thanks for this comment. We have replaced ‘correlation’ to ‘association’ in the method section. A multivariate analysis was planned however, only older age significantly predicted telemedicine satisfaction. Hence a multivariate analysis was not performed. It has been specified in the revised paper. “As per pre-specified criteria, if more than one variable had a P value of <0.05 ……………………………of interest significantly improved the prediction of satisfaction with telemedicine in the model”.

 

 

1. The statistical analysis section needs more explanation.

 

It has been described above in response to question 10 and 11.

Results:

1. Table 5 indicates that the authors used open-ended questions also. However, details are missing in the methodology section.

 

Thanks for the comments. We have specified it in the method. “The patient survey also contained an open ended section for comments”

 

1. Logistic regression analysis results must be presented in Table format.

 

A table (table 6) has been added in the revised paper.

Discussion:

Is it possible for the authors to provide their insight into the advantages and disadvantages of telemedicine and discuss how the healthcare service providers could best combine in-person service and online service to maximize the satisfaction of patients and service quality?  

 

Thanks very much for this suggestion. We have elaborate discussion section and highlighted the advantages and disadvantages of telemedicine and its use in post-pandemic era in cancer care (please see track change).

 

 

Reviewer 2

Thank you for submitting the manuscript. I read your paper with great interest, which deals with a highly topical issue that is increasingly present in the clinical and research fields. Your paper is readable, clear, and fluent. However, I would like you to broaden the discussion. In fact, two things need to be underlined: the limits of telemedicine and how covid-19 has changed telemedicine. In fact, telemedicine cannot be used without precautions, and without a visit in the presence. Furthermore, I would like you to underline more vigorously how the Pandemic has changed the way of doing telemedicine. In this regard, I suggest the following references:

 

Thanks very much for the important suggestions. We have elaborated discussion section and added few paragraphs to highlight the advantages and disadvantages of telemedicine and its use in cancer care in the post-pandemic era (please see track change). We have also added several new reference in relation to the discussion.

 

We sincerely thank the reviewers for their helpful comments. We hope that the changes we have made meet the expectations of the reviewers and that this work is now suitable for publication in Current Oncology.

 

 

Sincerely,

 

 

 

Shahid Ahmed, MD, FACP, FRCPC

Professor of Oncology

Saskatoon Cancer Center

University of Saskatchewan

20 Campus Drive

Saskatoon, SK

Canada, S7N4H4

Ph: 306-655-2710

Fax: 306-655-0633

Email: [email protected]

 

 

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for submitting the manuscript. I read your paper with great interest, which deals with a highly topical issue that is increasingly present in the clinical and research fields.Your paper is readable, clear, and fluent. However, I would like you to broaden the discussion. In fact, two things need to be underlined: the limits of telemedicine and how covid-19 has changed telemedicine. In fact, telemedicine cannot be used without precautions, and without a visit in the presence. Furthermore, I would like you to underline more vigorously how the Pandemic has changed the way of doing telemedicine.In this regard, I suggest the following references:

doi: 10.1093/pm/pnaa220.

• DOI: 10.3390/ijerph182312416
• doi: 10.1016/S0011-5029(99)90009-3.
• doi: 10.3390/ijerph182413372.I am convinced that after these small revisions it can acquire interest and readability.I hope my comments are useful to you.Kind Regards

Author Response

May 18, 2022

 

Dr. Sharlene Gill

Editor-in-Chief

Current Oncology                                                                                                                                                                                                 

RE: Patients and physicians’ satisfaction with telemedicine in cancer care in Saskatchewan: A cross-sectional study

Dear Dr. Gill

Thank you very much for your correspondence about the above manuscript submitted for consideration for publication in Current Oncology. We appreciated the comments made by the reviewers and have thoroughly addressed them in the second revision of the manuscript as described below:

Reviewer 1

Title:

1. Patients and physicians satisfaction? Kindly consider the apostrophe mark

 

Thanks for this comment. We have added apostrophe mark in the title.

Introduction:

1. Authors may consider updating the references as numerous references are more than 5-year-old.

 

We have updated the references and have replaced old citations with new citations.

 

1. Interestingly, the authors stated, “On average, patients from rural communities travel two to three hours to access health care not readily available to them close to their home (6)”. Is it in Canada or some other country? The reference is outdated. Kindly consider updating the latest one and changing the introduction accordingly.

 

It is a general statement for rural patients. We have included additional references relevant to travel distance from Canada, USA and Australia that have scatter populations in northern areas.

 

 

 

1. The research was conducted almost three years before. The authors need to explain more about linking the present study’s findings to the current scenario. Otherwise, this study may carry less value.

 

Thanks very much for this comments. This study was performed shortly before the COVID-19 pandemic. The COVID-19 pandemic has changed the delivery of care model in oncology and other specialty and virtual care has been adapted for a wider group of cancer patients regardless of their residence. The current study provides information on telehealth satisfaction in rural cancer patients prior to the pandemic that will be useful to clinicians, researchers, and policy makers.  We have added this information in the introduction section “As the COVID-19 pandemic has altered the model of care in oncology……………………….satisfaction with telemedicine among rural cancer patients during pre-COVID period”.

 

Methodology:

1. Did the authors include pediatric patients also (as the manuscript mentioned all patients)?

 

Only adult patients with cancer were included. It has been specified in the method section.

 

1. The authors did not explain the sampling method used to select the study participants.

 

Thanks very much for this comments. The consecutive sampling method was used. The sampling methods has been specified in the revised manuscript. “Consecutive sampling was used……………………… to participate in the survey”.   

 

1. The authors used a different number of items in paper vs. electronic format? How did you adjust during the analysis?

 

Thank you for this comments. We have performed separate analyses for patients and physicians.

 

 

1. Is the data collection tool of the present study adopted, or is the authors made? More explanation is required regarding items, validity, reliability etc

 

The survey was developed locally by adapting various tele-health satisfaction surveys. It was not validated. It has been clarified in method section (The survey was developed locally ………………………demographic and socio-economic variables”) and in the discussion section (The survey was ………… validated) in the limitations of the study.

 

 

1. A six-point Likert score was used for most survey questions. However, the authors did not mention anything about scoring.

 

The scoring is specified in the method section of the revised paper “A six-point Likert score from 1 to 6 (1=strongly disagree, 6=strongly agree) was used for ………………….an open ended section for comments”.

 

 

1. Logistic regression analysis was performed to assess the correlation between self-reported clinical and social factors and a positive telemedicine experience. However, the authors did not mention anything about grading.

 

We have elaborated the logistic regression in the method section. All variables were categorized into two category as described in the method section. Please see elaboration of logistic regression methodology in the revised manuscript (Track changes) 

 

1. The authors mentioned as logistic regression analysis was performed to find the correlation; kindly note that logistic regression analysis is done to identify the predictors. Also, why did the authors apply only univariate analysis, not multivariate analysis?

 

Thanks for this comment. We have replaced ‘correlation’ to ‘association’ in the method section. A multivariate analysis was planned however, only older age significantly predicted telemedicine satisfaction. Hence a multivariate analysis was not performed. It has been specified in the revised paper. “As per pre-specified criteria, if more than one variable had a P value of <0.05 ……………………………of interest significantly improved the prediction of satisfaction with telemedicine in the model”.

 

 

1. The statistical analysis section needs more explanation.

 

It has been described above in response to question 10 and 11.

Results:

1. Table 5 indicates that the authors used open-ended questions also. However, details are missing in the methodology section.

 

Thanks for the comments. We have specified it in the method. “The patient survey also contained an open ended section for comments”

 

1. Logistic regression analysis results must be presented in Table format.

 

A table (table 6) has been added in the revised paper.

Discussion:

Is it possible for the authors to provide their insight into the advantages and disadvantages of telemedicine and discuss how the healthcare service providers could best combine in-person service and online service to maximize the satisfaction of patients and service quality?  

 

Thanks very much for this suggestion. We have elaborate discussion section and highlighted the advantages and disadvantages of telemedicine and its use in post-pandemic era in cancer care (please see track change).

 

 

Reviewer 2

Thank you for submitting the manuscript. I read your paper with great interest, which deals with a highly topical issue that is increasingly present in the clinical and research fields. Your paper is readable, clear, and fluent. However, I would like you to broaden the discussion. In fact, two things need to be underlined: the limits of telemedicine and how covid-19 has changed telemedicine. In fact, telemedicine cannot be used without precautions, and without a visit in the presence. Furthermore, I would like you to underline more vigorously how the Pandemic has changed the way of doing telemedicine. In this regard, I suggest the following references:

 

Thanks very much for the important suggestions. We have elaborated discussion section and added few paragraphs to highlight the advantages and disadvantages of telemedicine and its use in cancer care in the post-pandemic era (please see track change). We have also added several new reference in relation to the discussion.

 

We sincerely thank the reviewers for their helpful comments. We hope that the changes we have made meet the expectations of the reviewers and that this work is now suitable for publication in Current Oncology.

 

 

Sincerely,

 

 

 

Shahid Ahmed, MD, FACP, FRCPC

Professor of Oncology

Saskatoon Cancer Center

University of Saskatchewan

20 Campus Drive

Saskatoon, SK

Canada, S7N4H4

Ph: 306-655-2710

Fax: 306-655-0633

Email: [email protected]

 

 

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Dear Authors,

Thank you very much for incorporating the suggestions/comments. There is a significant improvement in the manuscript (present format).

However, I suggest the following:

1. Adult patients eligible - does it mean all adults aged 18 years and above or age limits? please specify 

2. P-value - kindly change the P to p.

3. Selected comments from the opened ended questionnaire - Did the authors use any methods to select the comments to shortlist in the final paper?. This need to be mentioned in the methodology section.

I wish to congratulate the research team for the excellent effort.

With best regards

Author Response

Thank you very much for the communication about the above manuscript. We appreciated the positive comments by the reviewer and made additional changes as suggested.

Reviewer  

1. Adult patients eligible - does it mean all adults aged 18 years and above or age limits? please specify 

Thanks for the comment. Age limit of 18 years or above has been specified in the 2^nd revision.

2. P-value - kindly change the P to p.

Changes have been made.

3. Selected comments from the opened ended questionnaire - Did the authors use any methods to select the comments to shortlist in the final paper? This need to be mentioned in the methodology section.

Thanks for the comment. A thematic analysis of the comments were not performed and selected comments were presented by the investigators. It has been specified in the revised paper.

We are very thankful to the reviewer for the positive comments and hope that with changes the paper is now appropriate for publication in Current Oncology.