PONE-D-20-27620

A Patient Oriented Research Approach to Assessing Patients’ and Primary Care Physicians’ Opinions on Trauma-Informed Care

PLOS ONE

Dear Dr. Kokokyi,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The manuscript has been evaluated by two reviewers, and their comments are available below and attached.

The reviewers have raised a number of concerns that need attention. They request modifications to the reporting in the paper, and also ask about the validation of the questionnaire.

Could you please revise the manuscript to carefully address the concerns raised?

Please submit your revised manuscript by Apr 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Marianne Clemence

Associate Editor,

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

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https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

Furthermore, in the methods section, please address the following:

- a description of any inclusion/exclusion criteria that were applied to participant recruitment.

- a description of how participants were recruited.

3.We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I am thrilled to see a manuscript with this subject being considered for publication. Trauma-informed care (TIC) is a well-established framework for providing quality clinical care to survivors of various forms of trauma. TIC is rapidly growing in popularity and will soon affect the practice of all subspecialties of medicine. The authors have done an excellent job in conceptualizing and studying trauma-informed interventions that are proposed to impact patient care. The main strength of this article is its inclusion of perspectives from both physicians and patients. The data noted in the attached Tables were helpful and interesting. I have included comments throughout the manuscript with suggestions that I hope will be useful to the authors. One recommendation that I have is to include all introductory information re: trauma, TIC, definitions and epidemiology early on in the manuscript. It would also help to clarify how the authors selected their own key principles of TIC that differ slightly from SAMHSA's. I have also made recommendations for the authors to consider noting other published work on this subject that may be helpful and/or related. References to concepts such as emotional intelligence training in the manuscript can be more specifically tied to TIC (i.e. see Sanctuary Model, 2008). There were several instances throughout the discussion sections where I felt that the voice / insight / explanations of the primary care physician was not as clear as I would have hoped. I wonder whether collaboration with a PCP might be helpful in strengthening the interpretation of the results in the manuscript. Overall, this piece makes an important contribution to the field and would be wonderful to publish following edits as suggested. Thank you for the opportunity to review this paper.

Reviewer #2: Very well written and sound methodologies. The only question I have is regarding the measurement instrument, is it validated. If not, why the research team decided to use this approach--should also note as a limitation if not validated.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: PONE-D-20-27620_reviewer.pdf

PONE-D-20-27620R1

A patient oriented research approach to assessing patients’ and primary care physicians’ opinions on trauma-informed care

PLOS ONE

Dear Dr. Kokokyi,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 23 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

April Joy Joy Damian, PhD, MSc

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: -I very much appreciate the authors’ hard work in revising this manuscript. It was a completely different experience reading this version compared to the first. Impressive revision indeed! I would be likely to recommend this article to peers in TIC.

-The introduction is much clearer and helpful in defining TIC. The only area for improvement in the Intro is the final paragraph of the introduction. I would define Phase 1 with slightly more detail (ex. “In Phase 1, the research team examined physician and patient opinions of TIC” as well as Phase 2 “…for Phase 2’s examination of physician and patient recommendations for TIC applications”). Otherwise, references to Phase 1 and 2 in the intro lack meaning and leave lingering questions for the reader. Also in this paragraph, “the framework and six core principles” should be further clarified—whose framework? And SAMHSA’s six core principles? It would be best to specify “paraphrased by our team as…”. I would also expand the relevance of each of your principles from “patients” to include everyone in the system, because in a true trauma-informed organization (as defined in Tip 57), SAMHSA describes the principles as relevant for application to clients, family, staff, etc. For Cultural Sensitivity, consider adding a word that goes beyond awareness of biases and includes addressing them.

-The Phase 1 Methods are very well described.

-I love the focus on the IMPACT of trauma in the Discussion section of Phase 1. Physicians may have rated inquiry low b/c of unfamiliarity with trauma screening (PCPs in the U.S. are not trained in this at all)—might be helpful to note that. The sentence “Whereas simply knowing…” doesn’t seem like a complete sentence. There’s a key opportunity in this paragraph to mention “universal precautions” with TIC—it may not actually be relevant to know your pt’s trauma hx, if you apply these principles universally.

-In the Phase 2 section, 1st paragraph, would clarify “…patients did not perceive the __importance of?__ receiving TIC at the same level…”

-In the Phase 2 Results 3rd paragraph, would add an apostrophe for “…lower than physicians’…”

-In the final paragraph of the Phase 2 Results section, it would make more sense to switch these 2 sentences, as the phrase “clinical pathway” comes as a surprise to readers (hasn’t yet been mentioned). It would also be helpful to define what you mean by clinical pathway and what role it played in your study.

-In the Conclusion of the paper, I might adjust the 3rd sentence to more accurate reflect your results. Consider something to the effect of “…as pts find TIC important but do not perceive receiving it frequently.” I would strongly consider ending the conclusion on a positive note, rather than closing with a statement that includes the phrase “cost-effective”. Why do you think TIC is important? Do you think it’s possible to implement these strategies you’ve identified? What do you think would be the ultimate impact on physicians and patients, or healthcare on the whole?

Reviewer #3: This is an important investigation - there must be an understanding of how both the patient and the provider view TIC in order to increase the probability that the two will connect in a way that enhances the healing experience of the patient and gives instruction to the provider regarding how better to provide care. This study shows areas of concordance and discord between the two groups, which is a good starting point. The discussion of the reasons behind the answers endorsed be each group is necessarily speculative 9in the absence of focus groups or another method to get to the thought processes of providers and patients leading to the results. The discussion suggests that social determinants of health and historical institutionalized racism can be viewed through a trauma lens and this is likely a fruitful area for future work.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Reviewer Comments.docx

A patient oriented research approach to assessing patients’ and primary care physicians’ opinions on trauma-informed care

PONE-D-20-27620R2

Dear Dr. Kokokyi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

April Joy Joy Damian, PhD, MSc

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: