Delivery of Virtual Care in Oncology: Province-Wide Interprofessional Consensus Statements Using a Modified Delphi Process

Round 1

Reviewer 1 Report

Cheung et al present a manuscript describing the modified Delphi consensus process they went through to create consensus statements for virtual care in the province of Ontario, Canada. Virtual care has been widely adopted since the onset of the pandemic in various forms and it is of value for institutions to present and publish the guidance that they have established so other organizations can compare their policies. I commend the authors for taking this thorough approach with excellent methodology and think the manuscript is appropriate for publication.

I have limited criticisms of the manuscript. The systematic review that informed the initial round of discussion is quite old (April 2020) and early into the pandemic, however I do not think it would be reasonable to ask for this to be modified and I do not think even if it was refreshed that any new themes would be identified.

Author Response

We thank this reviewer for their comments.

While the original systematic review was conducted in April 2020 during the conception of this project, we incorporated findings from a systematic review in March 2021 conducted by Cancer Care Ontario.  We added a small edit to make this update more explicit in our paper (page 2, line 95).

Reviewer 2 Report

I enjoyed reading your manuscript, I believe it has a relevant and solid message, and the writing is clear. 

I was hoping to find some more background on the history of telehealth, and also some details on the workings of long-distance chemotherapy, as well as any common pitfalls or disadvantages of virtual care. I understand that is not the scope of your study, but should you wish to include some of that, it might be interesting to a broader audience interested in trying this approach. Thank you. 

Author Response

We thank this reviewer for their comments.

We agree that the history and early lessons of teleoncology are interesting and relevant. We briefly discuss them on Page 2, lines 52-60. Most teleoncology was originally developed to meet the needs of underserved patients (usually in rural or remote settings). A detailed re-collection of its history is out of the scope of this paper. However, it is something that the authors will consider in future work and also hope to encourage other researchers to explore as teleoncology continues to evolve.

Reviewer 3 Report

This is an interesting and important paper presenting guidelines for vritual care provision in oncology. The methods are well done and because of that, I don't have many additional comments. The majority of the comments pertain to style and I believe they will enhance the document:

• Please update the statement on line 40 p.1 about vaccination priority because most individuals are now vaccinated and perhaps mention of the booster/third dose makes more sense
• The term 'diverse' is used a few times and it is a bit unclear how this is being operationalized.
• Please add headings for limitations section and conclusions section (the last paragraph)

Author Response

We thank this reviewer for their comments.

1) We revised the statement re: vaccination to reflect their wider availability and ongoing concerns about emerging variants (pg 1, line 40).

2) We clarified that "diverse" alludes to the interprofessional group of clinicians and patient representatives that were part of the Consensus Group (pg 3, line 108).

3) We added "Strengths and Limitations" (pg 12, line 279) and "Conclusions" (pg 12, line 291) as headings.