Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Title: IJERPH-3991381   

Journal: International Journal of Environmental Research and Public Health Manuscript

Authors: Granata et al. 

Brief Summary:

The authors describe the design and rationale of the Illinois Cancer Health Equity Research (I-CHER) Center. 

Strengths:

1).  The authors do an excellent job describing the justification and need for a cancer health equity research center. 

2).  They also provide a lot of detail into a fairly complicated collaboration that may benefit others who may be interested in pursuing similar collaborations.

3).  The authors describe how the demographic characteristics of Cook County may contribute disparate cancer outcomes for medically underserved areas/populations. 

 

Comments:

After reading this paper, I am hard pressed to describe what the authors actually are attempting to do in this paper.  Line 70 purports to describe HOW the I-CHER achieved its objectives and provides a framework for how to achieve a solutions-based, multi-level, multi-sectorial infrastructure to address cancer disparities. However, it is not clear what the I-CHER objectives were.  The next section, Materials and Methods, goes on to describe the setting for the I-CHER, where it is housed, personnel, and partnerships. Then the authors describe their organizational framework- where they note that the “Center’s structure and activities represent a strategic response to national calls for advancing equitable access to precision cancer health through both building capacity and embedding innovation within FQHCs and community leaders in High risk communities.” ???

The authors then describe the different units- admin core, investigator development core, and the CAB.  Each of these is listed with aims, but none seem to refer to an actual objective for I-CHER.   

To summarize, my main concerns with this paper are:

1. The authors have submitted a design and rationale manuscript that includes somewhat limited information about the project’s design.

First, the authors describe the logic and why the I-CHER is needed.  But, their explanation of the components, structures, and expected impact is rather limited.  This is unfortunate, because this paper is very long.  And much of the narrative is focused on describing internal organizational characteristics that are not very useful for most readers.  In my mind, much of this paper isn’t applicable to most people who would read it.  For example, line 83, the UICC Director Jan Kitajewski is explained as “serving as the PI for the I-CHER center and ensuring optimal partnerships with the institution’s 7 health sciences colleges, shared scientific resources, and academic medical enterprise”.  In addition to being vague (how did one person ensure optimal partnerships with the institution’s 7 health sciences colleges?), is the reader better for knowing that it is Jan Kitajewski? 

  2).  The authors have a tendency to use vague language of evidence, without providing much actual evidence. 

This is evidenced in phrases like, “significant reach, high-impact infrastructure” etc. and are not terribly useful to the reader.    Moreover, the paper is quite long and doesn’t give useful depth on topics one would expect to see here.  For example, the authors also use phrases like “…the CAB is interwoven across the Center and its Cores. CAB leadership is integrated within the Admin Core and the IDC, with CAB members service as active reviewers and participants in decisions regarding scientific investments from the pilot project program.”  

Words like interwoven are vague and are not descriptive of what was actually done, or its impact.  In this instance, the phrase “…the CAB is interwoven across the Center and its Cores” is actually repetitive, because the next sentence provides the detail the reader is looking for.   

3).  The paper describes activity of the authors/collaboration, but not impact or innovation.

I am reluctant to critically review this paper because while I think it is well done-  to me, this isn’t a research paper.  It would be much better suited to a different type of publication- a white paper, or an evaluation paper.  I think that the paper attempts to describe how I-CHER’s organizational framework was organized and the roles that different entities played in this collaboration. 

The authors describe the I-CHER as “the hub for equity in precision cancer health within the University of Illinois-Chicago (UIC), a premiere research intensive, minority serving institution in the Midwest.”  There isn’t an objective or purpose to this paper- it seems to be largely descriptive of a collaboration between the organizations that make up the I-CHER. 

For example, the authors list the aims for each of the cores/CAB and lists their activities.  But do not describe the extent to which aims were achieved. 

4). Components missing from a design/rationale paper: 

While this is a design/rationale paper (and some of the conventions expected of a research paper might be relaxed), there are several things these types of papers need to, which these authors don’t in this manuscript:

              a). Describe theoretical uncertainties and the risks in implementation fidelity.

b). Explain anticipated challenges in data collection, or what measurement and evaluation gaps might exist. 

              c).  Lessons learned from early mistakes, miscues, and missteps.

              d). Describe tensions with partners and challenges in the development of the workforce. 

              e). The nature of the resource constraints. 

              f).  Negative feedback from CAB, partners, or stakeholders. 

For example, the authors describe multi-level reach (community level, systems level, provider level, patient-level).  For each, they provide some description of what happened, but not how.  For example, for the community level, they say community partners and co-investigators were further incorporated into multilevel interventions, with a focus on multi-sectorial strategies and coordination with the FQHC and safety net systems for optimizing access to precision cancer health services. Like, what did this look like?  How were community partners incorporated in this?  How was access to precision cancer health services optimized? 

Long story short- important limitations that should be present in this manuscript are missing.  The ones that are included seem more like the authors acknowledging structural dependency or institutional fragility, not actual scientific limitations. The overall effect is that this paper seems more suited for an internal audience and that its less rigorous (scientifically).   Combined with other elements absent in this manuscript (because it is not a design paper or an analysis), I am left with the feeling that there is little in this manuscript that is actionable for others looking to potentially implement such a cancer registry.  And the places where they provided detail, there still wasn’t enough detail to replicate what they did.       

 

 

Author Response

Authors’ Overall Response to Reviewer 1: We thank the reviewer for their constructive feedback and important considerations for improving the quality of the article. Resultantly, we have substantially revised our article, which is now a case report, based on the comments and concerns raised. By pivoting to a Case Report, the revised manuscript focuses more sharply on the rationale and design of the I-CHER Center as a replicable model, thus allowing it to serve as a 'blueprint' for other institutions, emphasizing our organizational framework and multi-sectoral collaboration over the empirical results of a single study. Below, we provide our responses and modifications to the initial feedback, which we have organized thematically to facilitate readability.

 

1. I am reluctant to critically review this paper because while I think it is well done- to me, this isn’t a research paper. It would be much better suited to a different type of publication- a white paper, or an evaluation paper. I think that the paper attempts to describe how I-CHER’s organizational framework was organized and the roles that different entities played in this collaboration. There isn’t an objective or purpose to this paper- it seems to be largely descriptive of a collaboration between the organizations that make up the I-CHER.

 

Authors’ Response: We tremendously value the reviewer’s feedback, which truly highlights the challenge of writing a design paper, and specifically a research center’s design, within the constraints of a research article format. Based on this feedback, we have engaged the editor for this special issue and have been approved to submit our revision as a case report, which “differs from articles and includes an Abstract, Keywords, Introduction, Detailed Case Description, Discussion, and Conclusions.” Accordingly, our revision now aligns with a more descriptive format for describing an example of administrative infrastructure for cancer equity research, while addressing some critical gaps that the reviewer identified.

 

2. The authors have submitted a design and rationale manuscript that includes somewhat limited information about the project’s design. While this is a design/rationale paper (and some of the conventions expected of a research paper might be relaxed), there are several things these types of papers need to, which these authors don’t in this manuscript. Components missing from a design/rationale paper:

 

1. It is not clear what the I-CHER objectives were.

 

Authors’ Responses: We appreciate the reviewer’s concern, in which our original manuscript outlined the original specific aims of the I-CHER Center, which should not be considered the same as the objectives of this descriptive case report. We now provide the manuscript’s objective: “The objective of this case report is to describe the I-CHER structure, administrative processes, early challenges, and early successes in research, workforce development, and policy / practice translation. We specify the anticipated implementation risks; participatory processes that were established across community, clinical, and academic sectors to ensure an equity-driven infrastructure; early challenges and tensions; and administrative solutions that contributed to early successes in research reach, work-force development, and policy / practice translation” (Lines 75-77). This objective more clearly specifies the manuscript’s focus on the Center and as a case report to describe the administrative infrastructure that may facilitate precision cancer health equity research, workforce development, and translation to practice and policy.  

 

1. Describe theoretical uncertainties and the risks in implementation fidelity.

 

Authors’ Response: In the limitations, we note that our key criteria for selecting research projects did not necessarily reflect their ability to address theoretical uncertainties – which is key for science to advance the nuanced understanding of multi-faceted, multilevel problems like precision cancer health equity. We note that this would be a critical element for future research centers to consider in their project selection processes. For the risks of implementation fidelity, we describe the Center structure and processes that were conducted to support research studies’ implementation and describe the processes that were conducted to support implementation fidelity of the Cores and CAB structure for the Center itself.

 

1. More information needed in terms of process. The places where they provided detail, there still wasn’t enough detail to replicate what they did. For example, the authors list the aims for each of the cores/CAB and lists their activities. But do not describe the extent to which aims were achieved. For example, the authors describe multi-level reach (community level, systems level, provider level, patient-level). For each, they provide some description of what happened, but not how. For example, for the community level, they say community partners and co-investigators were further incorporated into multilevel interventions, with a focus on multi-sectorial strategies and coordination with the FQHC and safety net systems for optimizing access to precision cancer health services. Like, what did this look like? How were community partners incorporated in this? How was access to precision cancer health services optimized?

 

Authors’ Response: We thank the reviewer for this important critique. We now provide more details regarding the activities across community, FQHC, and academic sectors in terms of the Center’s administrative processes. We offer a few examples regarding early challenges and tensions into coordination with FQHC and safety net systems, while highlighting that this is largely study-specific. We note that providing study-specific information is out of scope for this case report and might adversely impact future publications from study teams, who are in process of developing their respective design and empirical manuscripts. Nonetheless, we do provide a brief description in our Table 2, how community partners and FQHC / safety net systems were included for each study’s core team infrastructure.

 

1. Explain anticipated challenges in data collection, or what measurement and evaluation gaps might exist.

 

Authors’ Response: We appreciate the reviewer’s suggestions to provide more detail regarding anticipated challenges. We now highlight the diversity of common challenges in data collection, measurement, and evaluation that the I-CHER Center anticipated and the Center processes to monitor and respond nimbly to these challenges, as they rose.

 

1. The nature of the resource constraints

 

Authors’ Response: We now provide more detail regarding the resource constraints that our Center faced, which are common, and the strategies we used to overcome constraints, as appropriate.

 

1. Lessons learned from early mistakes, miscues, and missteps. Tension with partners and challenges in the development of the workforce. Negative feedback from CAB, partners, or stakeholders.

 

Authors’ Response: We now provide information regarding lessons learned, with a focus on lessons learned in terms of I-CHER as a research center and the early mistakes, miscues, and missteps in terms of an administrative infrastructure for cancer equity research. We highlight that study teams are developing their own empirical papers, regarding lessons learned for their specific community-clinical-academic teams and within the context of their research hypotheses.

 

1. Long story short- important limitations that should be present in this manuscript are missing. The ones that are included seem more like the authors acknowledging structural dependency or institutional fragility, not actual scientific limitations. I am left with the feeling that there is little in this manuscript that is actionable for others looking to potentially implement such a cancer registry.

 

Authors’ Response: We thank the reviewer for this thoughtful feedback. Our manuscript is now clearly described as a case report regarding the administrative infrastructure for cancer equity research. Accordingly, we focus on the limitations pertaining to establishing and maintaining administrative infrastructure. We also clearly highlight that our Center is not necessarily comprising a cancer registry, and that our Center-wide metrics are qualitative syntheses across diverse studies.

 

3. The authors have a tendency to use vague language of evidence. Words like interwoven are vague and are not descriptive of what was actually done, or its impact. This paper is very long. And much of the narrative is focused on describing internal organizational characteristics that are not very useful for most readers. In my mind, much of this paper isn’t applicable to most people who would read it. For example, line 83, the UICC Director Jan Kitajewski is explained as “serving as the PI for the I-CHER center and ensuring optimal partnerships with the institution’s 7 health sciences colleges, shared scientific resources, and academic medical enterprise”. In addition to being vague (how did one person ensure optimal partnerships with the institution’s 7 health sciences colleges?), is the reader better for knowing that it is Jan Kitajewski?

Authors’ Response: We have now condensed the article, including removing vague language, individual names, and all other institutionally specific information, as described above.

Reviewer 2 Report

Comments and Suggestions for Authors

I am simply confused by the paper. It is very well written but after thinking on it, it is not really a research article. Instead it is more like a report on the current structure of I-CHER. More information is needed to see how exactly this is a research article, instead it feels currently like a summary report that you may send to funders or for sharing with the general public. Information on methods and results needs to be enhanced.

I say this because to the best of my understanding, the entire methods section is not really methods. There is no real discernment between methods and results in this paper. The methods, as you can best describe them, are describing the creation and core functions of the research center as well as the general setup. It is not quite clear of what is happening in terms of a general research question being asked or addressed.

I believe this is a novel paper and warrants publication but it is not a research article. It is something different, like a case report something different. The paper would benefit the field by highlighting a very strong center for cancer research, education, training, and community outreach and offer a blueprint for replication by new and established centers. 

I do not really believe there is a way to improve the methods because it is so weak as a method, instead I suggest the paper change from a research article but seeing the types of articles IJERPH has, this is not possible. Instead, I would simply advise that this methods section is not really a traditional methods and should not be evaluated as such. I would ask the authors please specify the uniqueness of the methods in this paper and that this is not a traditional research article.

The references are appropriate and the conclusions match what is written here.

Author Response

1. I am simply confused by the paper. It is very well written but after thinking on it, it is not really a research article. Instead it is more like a report on the current structure of I-CHER. More information is needed to see how exactly this is a research article, instead it feels currently like a summary report that you may send to funders or for sharing with the general public. Information on methods and results needs to be enhanced. I say this because to the best of my understanding, the entire methods section is not really methods. There is no real discernment between methods and results in this paper. The methods, as you can best describe them, are describing the creation and core functions of the research center as well as the general setup. It is not quite clear of what is happening in terms of a general research question being asked or addressed. I believe this is a novel paper and warrants publication but it is not a research article. It is something different, like a case report something different. The paper would benefit the field by highlighting a very strong center for cancer research, education, training, and community outreach and offer a blueprint for replication by new and established centers. I do not really believe there is a way to improve the methods because it is so weak as a method, instead I suggest the paper change from a research article but seeing the types of articles IJERPH has, this is not possible. Instead, I would simply advise that this methods section is not really a traditional methods and should not be evaluated as such.

 

Authors’ Response: We deeply value this reviewer’s feedback and thank them for the time and effort they put into their critiques. In line with the overarching remarks of all reviewers, we collectively appreciate and acknowledge that the content of our manuscript better aligns with a case report rather than a research article and have coordinated with the Journal to resubmit the manuscript as such. It is our impression that submitting this work as a research article precluded the reviewers from being able to effectively critique our manuscript because the misaligned contents and structure proved to be an unavoidable hinderance on their critical evaluation. It is for this reason that we humbly request the reviewers revisit the newly revised manuscript of a case report and provide insight and critiques through the appropriate lens through which it should have been originally evaluated if it was submitted as a case report in the first place.  In line, our revision now more explicitly focuses on the administrative infrastructure of our Center, for growing cancer health equity research. 

 

2. I would ask the authors please specify the uniqueness of the methods in this paper and that this is not a traditional research article.

 

Authors’ Response: We agree with the reviewer that our original manuscript’s Methods section was mostly focused on administrative set-up and was not the type of methods section that is usually written for a research article. The Case Report format does not include a Methods section, but, in line with the reviewer’s suggestions, we do provide examples of the unique methodological innovations that different I-CHER research projects used. Specifically, we note the following innovations in basic and translational research:  “I-CHER’s equity-driven approach is unique in its application of fundamental research methods - including various mouse models (e.g., ACKR1 knock-outs), cell lines (e.g., 4T1 cells, drug-resistant to MRTX1133), patient biospecimens, and new screening technologies (e.g., circulating fragmentomics)- to MUA/P, a demographic sparsely represented in such mechanistic studies. These studies were focused on solutions that could be widely accessible in terms of delivery in primary care / FQHC settings (e.g., blood draws for lung cancer screenings) and community oncology settings (e.g., point-of-care therapies)” (Lines 299-306).

Reviewer 3 Report

Comments and Suggestions for Authors

 

Solution-based Research to Address Disparities in Precision Cancer Health: Design and Rationale of the Illinois Cancer Health Equity Research (I-CHER) Center

Introduction

Well composed

Methods

Remove identifiers, UICC cancer director/PI name on the manuscript

Figure 1: you may display titles without having to display individual names as that is not standard practice in peer reviewed articles but a normal practice in handbook

The information is good but a bit overwhelming to the reader. It is so extensive to the extent that it is hard to follow. If possible, please condense it.

Results

If possible, showcase sections 3.1.1 through 3.2.2 on a very simple table to provide a visual to your readers as the wording is lengthy.  

Discussion

Well summarized.

Is the model working in reducing cancer disparities?

Conclusion

Very well condensed

Author Response

1. Remove identifiers, UICC cancer director/PI name on the manuscript. Figure 1: you may display titles without having to display individual names as that is not standard practice in peer reviewed articles but a normal practice in handbook.

Authors’ Response: Thank you for your suggestion. We recognize that including names of individuals in specific roles provides unnecessary information and detracts from the reader understanding the roles and personnel that are essential to operate a center similar I-CHER; therefore, we have omitted all names of individuals in the manuscript’s main textual body and solely mention the relevant roles & positions.

2. Methods: The information is good but a bit overwhelming to the reader. It is so extensive to the extent that it is hard to follow. If possible, please condense it.

Authors’ Response: Upon revisiting the manuscript, we agree and have significantly overhauled the manuscript’s structure and narrative to improve readability. Specifically, we have streamlined the text by removing dense, distracting administrative details regarding anticipated risks and have now reframed the necessary information into a new ‘Implementation Challenges and Solutions” framework. Similarly, we also consolidated several descriptive-heavy sections of the text into a structured Table 3 that allows for the reader to visually ascertain the Center’s operational logic without the difficulties that can arise from sifting through granular details. We welcome and would appreciate any additional information to further facilitate readability of our article.

3. If possible, showcase sections 3.1.1 through 3.2.2 on a very simple table to provide a visual to your readers as the wording is lengthy.

Authors’ Response: We thank the reviewer for this excellent suggestion. We have submitted our revised manuscript as a Case Report, in line with feedback regarding our description of the administrative infrastructure for cancer health equity research, instead of a specific study on cancer health equity research. In line, we have worked to simplify the information within the “Detailed Case Description” section, including via a new Table 3. “Summary of I-CHER Implementation Risks/Challenges and Strategic Solutions” (pgs. 12-13) which directly synthesizes the content previously found in sections 3.1.1 through 3.2.2, and appreciate other suggestions to facilitate readability.

4. Is the model working in reducing cancer disparities?

Authors’ Response: We value the reviewer’s direct question. Given the time period between the center funding and this article’s submission, it has been challenging to obtain Center-wide data on efficacy, especially given many of our studies are actively in progress. While long-term Center-wide efficiency data is still being collected, we have noted several key early indicators of success that validate I-CHER’s model, including the successful dissemination of research findings to >300 members of the local cancer health disparities workforce (Lines 307-312) and translation of research findings into two pieces of Illinois State legislation (Lines 307-318). We, however, note this as an important future venue to expand upon, in the Discussion section.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for this updated case report. All questions were addressed and this is an excellent manuscript. No further comments.