The Art of Counseling in the Treatment of Head and Neck Cancer: Exploratory Investigation among Perceptions of Health Professionals in Southern Italy

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Thank you for the revisions that improved the manuscript. 

-       I confirm that the topic is very interesting, however a main issue remains unsolved: in my opinion, 19 participants cannot be considered representative of one third of Italy. Moreover, the regions included are: sicily (n°5), sardegna (n°1), campania (n°12), puglia (n°1). Puglia and Sardegna have only a respondents and other regions miss. So, results cannot be considered statistically significant. You need more participants to achieve significant and representative results.

-       In my opinion, “a group of 19 physicians, working in South Italy and selected according to their daily involved in H&N care, including oncologists and radiotherapists” cannot be considered a careful selection of respondents. For instance, how many years of experience in oncological field do they have? Did you include also “neospecialists” (e.g. less than 2 years of experience)?

-       In line 86 you should specify “SSCHN” since it’s the first time you write it.

-       In lines 87-99, you should write the region in brackets. In some cases, you wrote the city, in others you wrote the regions or nothing. Moreover, if you collected data about involved regions, this data could be clearer [for instance, sicily (n°5), sardegna (n°1), campania (n°12), puglia (n°1)].

-       In results section, you should correct the text because some periods are written in bold. You used different expressions to refer to “question number x” (question number 10, question nine, question n13, question n.6). I suggest using always the same expression.

-       In line 144, you should correct “umber one” with “number”.

-       In discussion section, as written above, about limits of the study, the number of respondents is very small and it cannot be considered representative, in my opinion. 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report (Previous Reviewer 2)

Dear Authors,

thank you for submitting an updated version of the manuscript. I noticed that you fulfilled the requested changes. There are still some english minor revision to do before considering the paper adapt for publication. Concerning the study design, it can be improved to: a better comment to the obtained Results could increase the quality of the Discussion.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report (Previous Reviewer 1)

In my opinion, the manuscript can be accepted in the current form.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

The role and the involvement of the patient with Head & neck cancer in choosing the best therapeutic strategy is a very important issue that should always be emphasized and stressed. Therefore, the idea of ​​the study is very interesting. However, the study presents several critical points:

-       Title: the study was carried out only on a sample from the city of Naples, not from Southern Italy.

-       Abstract: the acronyms SCCHN and H&N must be explained at least once before they can be used; it would be better to write the results with numerical data to be clearer and more scientific.

-       Material and methods:

o   19 specialists from the city of Naples cannot be defined as representative of Southern Italy.

o   The health professionals interviewed and their degree of experience in the oncology field are not very clear (Surgeons? Radiologists? Oncologists? Radiotherapists? Psychologists?)

o   No inclusion and exclusion criteria are specified. The selection of respondents is unclear.

o   The questionnaire presented in table 1 is not absolutely anonymous as you wrote (you ask for name and surname) and above all the acronyms SCCHN, HCP and ECM must be explained.

o   In question 14, which “counseling techniques” are you referring to?

o   Question 17 is too general and should be reformulated based on the own perception of self with respect to the obstacles in counseling with the patient.

-       Results: All the results of each question must be expressed with numerical data (as you have already done for questions 4 and 7) for a clearer and more immediate interpretation. Each question should, in fact, be exposed and analyzed individually. Open answers are difficult to summarize in numerical data but should still be analyzed and reported because they represent an important part of the questionnaire.

-       Discussion: The small sample and the interview selection method represent some limitations of the study that should be explained in discussion section.

-       Conclusions: Figures 1 and 2 do not provide any added value, as it is not even clear how the interviewees responded. The importance of multidisciplinary in the management of the cancer patient, which is repeated and emphasized several times in the study, is now a shared fact but does not represent the goal of the study. Therefore, a more accurate analysis of the results should be done in order to achieve more inherent and clear conclusions.

-       References: 7 out of 15 references were published more than 10 years ago. It would be advisable to use mostly recent publications (within the last 5 years) wherever possible.

Reviewer 2 Report

Dear Authors, 

Thank you for submitting this interesting paper. The study is well designed and well conducted, with just few point to clarify. I think that you should improve the Results presentation: add percentage to ratio (ex. "12 out of 19," 63%), and use always numbers when referring to partecipants (ex. "only 5 specialists"), just to make easier the interpretation. 

Line 73: rephrase the sentence better, what are the strengths and weaknesses?

Table 1, question 4, point 3: colleagues

Table 1, question 5: uniform the words "patient focused" with "patient-focused"

Table 1, question 9, point 3: comfortable