PONE-D-23-40586Simultaneous pancreas and kidney transplantation: A qualitative study of partners’ experiencesPLOS 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: Yes

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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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: No

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: Thank you for the chance to review this paper. It represents important perspectives of partners in relation to pancreas and kidney transplants. I have written a couple of questions and points of clarification below. Best wishes forward!

Introduction

The study is introduced with a relevant literature review and clear rationale for the study. The structure and logic of the text is helpful for readers.

Methods

The research process is clearly described and using the SRQR checklist is helpful. I have a question about recruitment, 15 partners were invited to participate, and 8 decided to do so. How did you decide that the 15 and the 8 were sufficient? Thinking of the four research questions, it seems it would have been a benefit to have a few more participants.

The interview guide is extensive and seems very structured. The concept quality of life is central in several questions. In the introduction, quality of life is mentioned once, as is well-being, health and life satisfaction. Perhaps other types of questions and foci would have generated different findings.

Findings

The findings are presented in six themes. The second theme is presented with two sub-themes, one covering two pages and one about ¼ of a page. I am uncertain about the reasoning behind this choice. In my reading it comes across as confusing and makes me wonder about balance in presentation of findings. Do the sub-themes contribute in a significant way?

The theme “Got on with it” is also quite short, perhaps it would make sense to merge it with another theme. My general impression of the findings is that they could be condensed and refined further for greater balance.

Discussion

The discussion dives straight into highlighting a few of the findings, fear of hypoglycemia, prioritizing their partner before themselves, getting on with it and relief after the transplantation. Please consider signposting this at the start of the discussion; it would be helpful for readers. Perhaps starting with a brief summary of the main findings could be useful.

It may also be helpful to consider the main message of the discussion; what should readers take or learn from these findings. Parts read a bit repetitive in comparison to the results.

The study limitations would benefit from considering a wider scope of the research process. At present only selection bias and gender are commented on. For example, trustworthiness and credibility of the findings could be elaborated.

Conclusion

The conclusion highlights health and well-being of the participants. Quality of life is not mentioned, which is a bit tricky as it is frequently used in the interview guide.

Reviewer #2: An important interview study with patners/caregivers of people requiring a SPK transplant. Some suggestions for improvement include:

1. This is a small sample size and I believe that needs to be acknowledged in the limitations paragraph.

2. Could you please clarify if all the partners where co-habitating with the person with kidney failure, as this may alter their experiences.

3. Was data saturation reached. I realize you only interviewed the 8/15 who responded but I want o know in the main body of the paper did you reach data saturation?

4. Findings - your themes and subthemes could do with another revision. They are very matter of fact and not conveying the true nature of the theme ie Living with worry- this could be improved to highlight the tre nature of the theme by including persistent or pervasive. Alos some of the themes have large bodies of writing that I feel highlight some subthemes that are important - impact on partners work for an example. Pleases revise and deduce whether further subthems could be highlighted.

5 For contextual assistance was this study conducted in city or rural areas as that does impact burden for partners and highlights further issues.

Thanks

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Reviewer #1: Yes: Anna Klarare

Reviewer #2: No

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Simultaneous pancreas and kidney transplantation: A qualitative study of partners’ experiences

PONE-D-23-40586R1

Dear Dr. Gibbons,

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.

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Additional Editor Comments (optional):

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

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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

**********

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

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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: Thank you for your meticulous revisions and thoughtful responses. Your study is a valuable addition with rich information about partners' experiences related to transplantation. Best wishes forward!

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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: Yes: Anna Klarare

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