Dear Dr. Sindet-Pedersen,

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PLOS ONE

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This study has been funded by the Danish Heart Foundation, Grant number: A9530.

And by an unrestricted grant from Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis' Legat

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This study has been funded by the Danish Heart Foundation, Grant number: A9530. And by an unrestricted grant from Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis' Legat

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This study has been funded by the Danish Heart Foundation, Grant number: A9530.

And by an unrestricted grant from Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis' Legat

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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?

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: 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: No

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Thank you for giving me the opportunity to review your manuscript entitled “The Physical and Psychological Well-Being After a Pulmonary Embolism Across Age and Comorbidities – Evidence from Focus Group Interviews.” I very much enjoyed reading your manuscript.

Summary:

The manuscript "The Physical and Psychological Well-Being After a Pulmonary Embolism Across Age and Comorbidities – Evidence from Focus Group Interviews" explores the long-term physical and psychological effects experienced by patients who have had a pulmonary embolism (PE). The study employs a qualitative approach using focus group interviews with patients recruited from an outpatient thrombosis clinic. The findings highlight that PE survivors frequently experience persistent symptoms such as fatigue and dyspnea, with varying levels of emotional and physical impact based on age, comorbidities, and risk factors such as cancer or pregnancy-related PE. Younger patients often report greater disruptions in their daily lives and a heightened sense of vulnerability, whereas older patients tend to attribute symptoms to aging. The study also identifies a "medication conundrum", where patients view anticoagulation therapy as lifesaving yet simultaneously feel a sense of chronic illness due to long-term medication use. Additionally, the study underscores a significant gap in follow-up care, with patients expressing frustration over the lack of post-PE guidance, rehabilitation strategies, and reassurance regarding recovery. The authors conclude that a personalized approach to post-PE care, tailored to age and comorbidity profiles, is necessary to improve patient outcomes. While the study provides valuable insights, further exploration of structured rehabilitation programs and targeted interventions for different patient groups could enhance its clinical applicability.

Major Comments:

1. Theory Contribution:

- The study presents important patient-centered insights into post-PE recovery, but the theoretical framework could be more explicitly defined. The authors identify a gap in post-PE care and propose a more individualized, multidisciplinary approach; however, the manuscript would benefit from a clearer articulation of how these findings advance existing theories on chronic illness management, rehabilitation, and patient-centered care. The concept of the "medication conundrum" is particularly compelling and could be further expanded—does this align with known models of chronic disease burden, or does it present a novel perspective? Discussing how these findings contribute to new patient support frameworks would enhance the study’s theoretical impact.

2. Methods:

The qualitative approach using focus group interviews is appropriate for exploring patient experiences, but additional details on study design, data collection, and analysis are needed for transparency and reproducibility. The manuscript should clarify:

- What was the justification for the sample size?

- How did the authors determine that saturation was reached?

3. Results:

The study presents valuable insights into post-PE experiences, but the results section could be better structured to highlight key themes more clearly. While the findings are significant, their impact could be strengthened by:

- Summarizing main themes in a table format for better readability (e.g., theme, representative quotes, implications).

- Providing a more detailed comparison between younger and older patients’ experiences. Are there any quantifiable differences in reported symptom burden?

Minor Comments:

1. In-text citations: You may ensure consistent formatting throughout the manuscript.

2. Study settings and participants: You may revise lines 13–19 for correct punctuation to improve clarity.

3. Line numbers: You may ensure continuous numbering throughout the document rather than restarting on each new page or section.

4. Patient quotations: You may consider presenting them in a table format to improve readability and flow instead of embedding them extensively within the text.

5. Tables:

- You may ensure that text in the first row is written horizontally, not vertically.

- You may confirm that numbers in the second column are formatted horizontally, not vertically.

Reviewer #2: This study provides valuable qualitative insights into the lived experiences of PE patients, particularly the interplay between age, comorbidities, and post-PE well-being. The findings have significant potential to inform patient-centered care strategies and highlight critical gaps in post-PE rehabilitation.

Major Concerns and Recommendations

1. Sample Size and Composition

- Comment: Small sample size (n=17), particularly for subgroups (e.g., 2 cancer patients, 1 pregnancy-related PE), limits transferability. The single participant focus group deviates from the standard focus group methodology, potentially reducing data richness.

- Recommendation: Acknowledge these limitations more explicitly in the discussion. Despite being singular, consider adding a statement on how the pregnancy-related PE case aligns with broader themes to justify its inclusion.

2. Methodological Transparency

- Comment: Limited details on how researchers resolved coding discrepancies.

- Recommendation: Clarify the process of resolving disagreements during coding (e.g., consensus meetings, third-party arbitration) to enhance dependability.

3. Ethical and Reproducibility Considerations

- Comment: Data availability is restricted due to GDPR, which is understandable but limits reproducibility.

- Recommendation: Provide a more detailed anonymized raw data summary (e.g., de-identified quotes or themes) in supplementary materials to improve transparency.

5. Conflict of Interest (COI)

- Comment: While COIs are declared, the potential influence of pharmaceutical funding (e.g., Bayer, Pfizer) on interpretation is not addressed.

- Recommendation: Add a brief statement affirming that funders had no role in study design, data interpretation, or manuscript preparation.

Minor Revisions

1. Abstract: Clarify the “unrestricted grant” source in the funding statement.

2. Results:

- Define abbreviations at first mention (e.g., “OAC” in Table 1).

- Standardize participant identifiers (e.g., “Ma (38)” vs. “K (79)”—ensure consistency in pseudonyms).

3. Discussion:

- Expand on how cultural context (Danish healthcare system) may influence follow-up care perceptions.

- Compare findings to similar qualitative studies (e.g., Danielsbacka et al., 2021) to contextualize originality.

Recommendation: Accept with Minor Revisions

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Reviewer #1: Yes: Ibrahim SalehIbrahim Saleh

Reviewer #2: Yes: Noha YasenNoha Yasen

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Attachments

Attachment

Submitted filename: Noha review.docx

Dear Dr. Sindet-Pedersen,

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 Jan 02 2026 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.. 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.

• 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 . 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,

Yoshihiro Fukumoto

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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

Reviewer #1: Yes

Reviewer #2: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: Thank you for letting me review your revised manuscript. The authors have adequately addressed all the reviewer comments. I have no further comments to add.

Reviewer #2: This manuscript presents a relevant and well-motivated qualitative analysis of physical and psychological well-being following pulmonary embolism (PE). The topic is important and underrepresented in the literature, and the authors successfully highlight patient perspectives across different ages and comorbidity backgrounds. The findings are valuable and have potential clinical implications for post-PE follow-up and rehabilitation.

However, several aspects require revision:

• Provide clearer justification for the sampling strategy and explain more precisely how data saturation was determined.

• Expand on researcher reflexivity and positionality, as these aspects are essential for evaluating qualitative rigor.

• Clarify coding procedures (inductive vs theory-informed), describe how agreement was achieved, and specify whether member checking was conducted.

• Introduce theoretical frameworks (Leventhal’s model, biographical disruption) earlier in the manuscript instead of only in the Discussion.

• Strengthen the ethics section with a clearer explanation of the waiver for qualitative interviews.

• Improve language consistency and correct minor grammatical errors.

Overall, I recommend Major Revision, as the study has strong potential and will significantly benefit from improved methodological transparency and clearer integration with existing theoretical models.

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what does this mean? ). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our Privacy Policy .-->

Reviewer #1: Yes: Ibrahim SalehIbrahim Saleh

Reviewer #2: Yes: Noha samy yasenNoha samy yasen

**********

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The physical and psychological well-being after a pulmonary embolism across age and comorbidities – Evidence from focus group interviews

PONE-D-24-56228R2

Dear Dr. Sindet-Pedersen,

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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Kind regards,

Yoshihiro Fukumoto

Academic Editor

PLOS One

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