PONE-D-23-04985Clients’ and genetic counselors’ perceptions of empathy in Japan: A pilot study of simulated genetic counseling sessionsPLOS ONE

Dear Dr. Tomozawa,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: No

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: The English should be reviewed by a native speaker for clarity and meaning.

I will point out some of the specific sentences that need attention with “clarity/meaning:” when I dont know how to edit for clarity. And in other cases I suggest alternate wording.

Abstract:

Clarity/meaning: “Client-counselor interactions about empathy involve a significant element in genetic counseling, which is an area of increasing need with the rapid acceleration of genetic testing across medical conditions and needs.”

Suggest changing: “This study aims to reveal the perceptions of empathy in clients and genetic counselors during simulated genetic counseling sessions” to “This study aimed to explore the perceptions of empathy in simulated genetic counseling sessions from the perspectives of clients and genetic counselors”

Suggest changing: “Semi-structured interviews with participants of simulated genetic counseling sessions and interpersonal process recall were used to elicit their experiences of empathy” to: “Semi-structured interviews and interpersonal process recall were used with participants of simulated genetic counseling sessions to elicit their experiences of empathy”

Suggest changing: “A constructing grounded theory was used for data analysis” to: “A constructivist grounded theory was used for data analysis”

Suggest changing: “A total of 15 participants, 10 acting as clients and 5 as genetic counselors, participated in 10 simulated counseling sessions” to: “A total of 15 participants, including 10 clients and 5 genetic counselors, participated in 10 simulated counseling sessions.”

Clarity/meaning: “Clients’ perception represented genetic counselors’ empathic approaches, their subjective thoughts brought by the approaches and those changes”

Then suggest putting the sentence about counsellors attempts to demonstrate empathy first, and follow it with the sentence about clients reactions to the demonstrations of empathy.

Introduction

Suggest deleting “the psychometrics of” from this sentence: “Regarding empathy in the physician-patient relationship, the psychometrics of the patient’s view of the physician’s…” and changing the word “compliance” to “adherence”

Instead of “cancer patients” use “patients with cancer”

Suggest deleting “the sense of” in this sentence: “there is a lack of empirical data about the sense of empathy in genetic counselors.”

Change: “. The aim of this pilot study is to reveal the clients’ perceptions of empathy in the genetic counseling context by analyzing simulated sessions.” To ”. The aim of this pilot study was to explore counsellors’ and clients’ perceptions of empathy in the genetic counseling context by analyzing simulated sessions.”

[amemdment: having read the whole manuscript, it seems to be about THE PROCESS through which empathy is experienced in genetic counseling, rather than just empathy in general - suggest rewording the above accordingly]

Change: “However, IPR was difficult to adopt for clients in clinical settings for the feasibility of this study that was conducted to fulfill a degree requirement. Therefore, our survey targeted simulated genetic counseling session” to “Due to the difficulties associated with using IPR for clients in clinical settings, our survey targeted simulated genetic counseling session…”

Methods:

More information is required about the methodology chosen. Specifically why was grounded theory chosen ? How was it actually operationalized within a constructivist paradigm? This sentence makes it sounds actually rather like the approach taken was closer to positivist or post positivist than constructivist: “Coding and theorizing procedures were repeated to reach consensus between both author”. Suggest the authors examine https://onlinelibrary.wiley.com/doi/10.1002/jgc4.1644 Further, what was the underlying conceptual framework?

The following suggests that the authors are alluding to the concept of “saturation”: “Data collection was completed when new categories were not generated after new data addition” - however, the specifics and evidence of having reached saturation is missing.

Results

The data provided are very thin there are very few direct quotes from participants- the value of qualitative approaches is typically within the richness of the data, the depth of understanding of participants perspectives and experiences. In this manuscript, the few quotes that are provided are all within table 4, and are separated into counselor and client quotes. This presentation feels very positivist and does not allow for true appreciation of the way in which the different components of the model interrelate.

The authors indicate that they built a theoretical model - it’s not clear what exactly the model is of (perhaps see the comment above about the process of developing , and there is no overarching description of how all of the components of the model fit together.

Reviewer #2: Thank you for the opportunity to review this study exploring Japanese genetic counsellors’ experiences of empathy in simulated consultations. The study contributes to our understanding of what occurs between client and genetic counsellor within a clinical interaction. Use of simulated consultations and IPR builds on earlier work conducted in North America. The authors of this paper bring a reflective and considered Japanese cultural understanding to this process study.

The majority of the paper is very well written and easy to read. The abstract is not as clear as the rest of the paper and includes some grammatical errors. Editing the abstract to ensure the meaning is clear will help increase the profile of this work.

The term simulation can be used to mean a simulated consultation (as in this paper) or a learning experience (as described in a recent genetic counselling paper by Jacobs & McEwen, 2021). Simulation can also be used as a form of assessment. It would be helpful to include a definition of simulation as used by these authors, and to consider whether simulated consultation is a more appropriate term.

The authors discuss the possibility of using simulation to develop empathy in genetic counselling education and training. Including literature where simulation has been used with learning outcomes that include developing effective client-counsellor relationships would further support the discussion. This paper may be of interest.

Jacobs, C. and McEwen, A. (2021). Adapting to the challenges of the global pandemic on genetic counselor education: Evaluating students’ satisfaction with virtual clinical experiences. J Genet Couns. 2021;30:1074–1083 DOI: 10.1002/jgc4.1490

I encourage the authors to proofread the manuscript prior to publication to correct any minor errors.

Thank you for this work, demonstrating the value of simulated consultations in understanding what occurs within a genetic counselling consultation.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-04985R1Clients’ and genetic counselors’ perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counselingPLOS ONE

Dear Dr. Tomozawa,

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.==============================

Dear authors,

thank you first of all for submitting such an interesting article. 

In line with what one of the reviewers suggested, I would kindly ask you to make the suggested changes. 

==============================

Please submit your revised manuscript by Aug 13 2023 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: https://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,

Ramona Bongelli, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

1. 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.

Additional Editor Comments:

Dear Authors,

Thank you for reviewing your paper.

I would ask you to make the last minor revisions suggested by one of the reviewers.

Good work

Ramona Bongelli

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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: (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

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

Reviewer #1: N/A

**********

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

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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

**********

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: This manuscript has improved markedly from the first submission, the authors are commended for their work.

The following comments are offered to further improve the usefulness of the manuscript.

Abstract:

Suggest changing the first two sentences of the abstract to read as follows:

The rapid increase of the availability of genetic testing is driving the acceleration of genetic counseling implementation. Empathy is important in medical encounters in general, and forms a core component of a successful genetic counseling session, but there ilittle empirical data about empathy in genetic counseling.

Methods

The authors discuss that they are male and female, and expect that the participants would be female… but its not actually clear in how the language is being used whether the authors are referring to sex or gender. Clarity on this would be useful. Especially as the discussion comments: “There are also cultural and gender differences in communication characteristics [43,44], and our data might only be representative of the perspectives of Japanese women.” Please note that while “women” is a term that refers only to gender and not sex, “female” is typically used to refer to sex but can also be used to refer to gender.

It would also be useful to make explicit whether counsellor and client IPR interviews were conducted separately or together.

How was it decided which sections of the video related to empathy, and who made that decision? This should be included in the manuscript.

The rationale for choosing grounded theory as a methodology is not strong as currently written. Specifically, there are many approaches that can apply the constant comparative method ( described in lines 157-132), rather not all qualitative methodologies aim to produce a theory of a process - this seems to be the most compelling reason to choose this methodology for this work. Suggest rewording accordingly.

Please check through the manuscript and ensure that themes are not referred to as “emerging” (e.g. p31)n- as this term suggests that they are objectively present, which runs counter to the premise of constructivism

Discussion

having participated as a counsellor in a simulated genetic counseling session, I wonder whether there is any chance that the fact that it is simulated might interfere with or influence the ways in which empathy manifests in a session. This might warrant mention in the discussion (if there is any literature about this) or limitations.

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Reviewer #1: No

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Clients’ and genetic counselors’ perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counseling

PONE-D-23-04985R2

Dear Dr. Tomozawa,

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,

Ramona Bongelli, Ph.D.

Academic Editor

PLOS ONE

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