Reviewer ’s report  
 
Title: Patient views about the impact of ulcerative colitis and its  management with drug 
treatment and surgery: a nested qualitative study within the CONSTRUCT trial  
 
Version: 1 Date: 04 Sep 2019  
 
Reviewer: Ksenia Gorbenko  
 
Reviewer's report:  
 
I commend the authors on a well written manuscript reporting on a nested qualitative study. 
The longitudinal aspect of the study (inter viewing the same patients at two points in time) is a 
definite strength; so is the stratified sampling strategy that allowed you to compare patients 
on two types of medication (infliximab and ciclosporin) and those with and without surgery. I 
have a few su ggestions to improve the quality of your manuscript further.  
 
1. Lines 474 -476: you mention funding restrictions on infliximab - perhaps a word 
explaining these might help readers to understand the context of those for readers not 
located in the UK? A sen tence in the introduction or discussion would be sufficient.  
 
2. Lines 484 -486: You mention that patients reported a sense of loss after colectomy, but 
this patient talks about walking out of somewhere "without a bag" - it is confusing 
whether the patient w as able to avoid surgery? What was the context of this quote? 
Please provide more explanation or use a different quote.  
 
3. You mention "coping" and "coping strategies" a few times in the manuscript, but it 
seems the focus of the interviews was not so much on how patient coped, but more on 
the burden of the disease. E.g. in line 351, you mention patients having to "cope with 
a stoma" but there are no specific details on what they had to learn to do, or how they 
adjusted or changed their behavior when living with a stoma. Similarly in lines 632 -
634 you talk about "dramatic coping strategies" that patients undertook such as 
"curtailment of holidays, stopping hobbies, and attending of sports events." Again, 
these seem to be more of a burden/ impact of the diseas e rather than adjusting to the 
disease. In my view, a coping strategy would be, for example, installing a toilet 
location app on the smartphone, or asking a loved one to call them on the phone 
during an infusion. If you have any concrete examples of coping  in your data, you 
may include them (the idea being that these might be helpful to other patients). If not, 
I would recommend changing the term throughout to "learning to live with the 
disease."  
 
Overall, great article! I look forward to seeing this artic le in print.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or 
salary from an organisation that may in  any way gain or lose financially from 
the publication of this  manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 
or lose financially from the publication of this manuscript, either now or in the 
future?  
 
3. Do you hold or are you currently applying for any patents  relating to the 
content of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an 
organization that holds or has applied for patents relating to t he content of the 
manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing intere sts' 
below. If your reply is yes to any, please give details below.  
 
Co-investigator on Abbvie, Inc. and Pfizer, Inc. funded educational projects.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be 
included on my report  to the authors and, if the manuscript is accepted f or publication, my 
named report including any attachments I upload will be posted on the website along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments which I do not wish to be included in my named report can be included as  
confidential comments to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Patient views about the impact of ulcerative colitis and its  management with drug 
treatment and surgery: a nested qualitative study within the CONSTRUCT trial  
 
Version: 1 Date: 04 Sep 2019  
 
Reviewer: Ksenia Gorbenko  
 
Reviewer's report:  
 
I commend the authors on a well written manuscript reporting on a nested qualitative study. 
The longitudinal aspect of the study (inter viewing the same patients at two points in time) is a 
definite strength; so is the stratified sampling strategy that allowed you to compare patients 
on two types of medication (infliximab and ciclosporin) and those with and without surgery. I 
have a few su ggestions to improve the quality of your manuscript further.  
 
1. Lines 474 -476: you mention funding restrictions on infliximab - perhaps a word 
explaining these might help readers to understand the context of those for readers not 
located in the UK? A sen tence in the introduction or discussion would be sufficient.  
 
2. Lines 484 -486: You mention that patients reported a sense of loss after colectomy, but 
this patient talks about walking out of somewhere "without a bag" - it is confusing 
whether the patient w as able to avoid surgery? What was the context of this quote? 
Please provide more explanation or use a different quote.  
 
3. You mention "coping" and "coping strategies" a few times in the manuscript, but it 
seems the focus of the interviews was not so much on how patient coped, but more on 
the burden of the disease. E.g. in line 351, you mention patients having to "cope with 
a stoma" but there are no specific details on what they had to learn to do, or how they 
adjusted or changed their behavior when living with a stoma. Similarly in lines 632 -
634 you talk about "dramatic coping strategies" that patients undertook such as 
"curtailment of holidays, stopping hobbies, and attending of sports events." Again, 
these seem to be more of a burden/ impact of the diseas e rather than adjusting to the 
disease. In my view, a coping strategy would be, for example, installing a toilet 
location app on the smartphone, or asking a loved one to call them on the phone 
during an infusion. If you have any concrete examples of coping  in your data, you 
may include them (the idea being that these might be helpful to other patients). If not, 
I would recommend changing the term throughout to "learning to live with the 
disease."  
 
Overall, great article! I look forward to seeing this artic le in print.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or 
salary from an organisation that may in  any way gain or lose financially from 
the publication of this  manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 
or lose financially from the publication of this manuscript, either now or in the 
future?  
 
3. Do you hold or are you currently applying for any patents  relating to the 
content of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an 
organization that holds or has applied for patents relating to t he content of the 
manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing intere sts' 
below. If your reply is yes to any, please give details below.  
 
Co-investigator on Abbvie, Inc. and Pfizer, Inc. funded educational projects.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be 
included on my report  to the authors and, if the manuscript is accepted f or publication, my 
named report including any attachments I upload will be posted on the website along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments which I do not wish to be included in my named report can be included as  
confidential comments to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Patient views about the impact of ulcerative colitis and its  management with drug 
treatment and surgery: a nested qualitative study within the CONSTRUCT trial  
 
Version: 1 Date: 04 Sep 2019  
 
Reviewer: Ksenia Gorbenko  
 
Reviewer's report:  
 
I commend the authors on a well written manuscript reporting on a nested qualitative study. 
The longitudinal aspect of the study (inter viewing the same patients at two points in time) is a 
definite strength; so is the stratified sampling strategy that allowed you to compare patients 
on two types of medication (infliximab and ciclosporin) and those with and without surgery. I 
have a few su ggestions to improve the quality of your manuscript further.  
 
1. Lines 474 -476: you mention funding restrictions on infliximab - perhaps a word 
explaining these might help readers to understand the context of those for readers not 
located in the UK? A sen tence in the introduction or discussion would be sufficient.  
 
2. Lines 484 -486: You mention that patients reported a sense of loss after colectomy, but 
this patient talks about walking out of somewhere "without a bag" - it is confusing 
whether the patient w as able to avoid surgery? What was the context of this quote? 
Please provide more explanation or use a different quote.  
 
3. You mention "coping" and "coping strategies" a few times in the manuscript, but it 
seems the focus of the interviews was not so much on how patient coped, but more on 
the burden of the disease. E.g. in line 351, you mention patients having to "cope with 
a stoma" but there are no specific details on what they had to learn to do, or how they 
adjusted or changed their behavior when living with a stoma. Similarly in lines 632 -
634 you talk about "dramatic coping strategies" that patients undertook such as 
"curtailment of holidays, stopping hobbies, and attending of sports events." Again, 
these seem to be more of a burden/ impact of the diseas e rather than adjusting to the 
disease. In my view, a coping strategy would be, for example, installing a toilet 
location app on the smartphone, or asking a loved one to call them on the phone 
during an infusion. If you have any concrete examples of coping  in your data, you 
may include them (the idea being that these might be helpful to other patients). If not, 
I would recommend changing the term throughout to "learning to live with the 
disease."  
 
Overall, great article! I look forward to seeing this artic le in print.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or 
salary from an organisation that may in  any way gain or lose financially from 
the publication of this  manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 
or lose financially from the publication of this manuscript, either now or in the 
future?  
 
3. Do you hold or are you currently applying for any patents  relating to the 
content of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an 
organization that holds or has applied for patents relating to t he content of the 
manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing intere sts' 
below. If your reply is yes to any, please give details below.  
 
Co-investigator on Abbvie, Inc. and Pfizer, Inc. funded educational projects.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be 
included on my report  to the authors and, if the manuscript is accepted f or publication, my 
named report including any attachments I upload will be posted on the website along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments which I do not wish to be included in my named report can be included as  
confidential comments to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant