Title: Patient preferences of healthcare delivery in irritable bowel syndrome: a focus group study
Version: 0 Date: 27 Sep 2021
Reviewer:  Greger Lindberg
Reviewer's report:
This is a qualitative study with focus groups of needs for patients with IBS. The authors claim
that multidisciplinary treatment teams, centers of expertise and clear communication are needed
for patients with IBS. Although I sympathize with the unique employment of focus groups for
identifying the needs of patients with IBS there are a couple of issues with the present study that
need clarification or amendments.
1. The concept “centers of expertise” is actually introduced by those performing the interviews.
Isn’t there an obvious risk for bias if you ask “How do you feel about centers of expertise for
IBS care?” and “Which type of healthcare givers would you like to be involved in IBS centers
of expertise?” Do you think centers of expertise would have come up had you not mentioned
them to the participants? Please discuss these matters. Apart from the bias, would you say that
all patients with IBS would benefit from IBS centers of expertise? See also item #2 below.
2. I am uncertain about the representativeness of the 24 subjects included in this study. To
begin with the proportion of people who fulfil the Rome-III or Rome-IV criteria for IBS is quite
substantial and somewhere between 10-20 %. However, the proportion of people who receive the
diagnosis of IBS in primary or secondary care amounts only to 1-2 %. All subjects in this study
had been diagnosed by a doctor, so the participants came from the smaller (1-2 %) population
of people with IBS-like symptoms. Those are the patients who actually seek medical advice
for their symptoms (but the majority do not). So this smaller group consists of those that seek
answers. Some of those, do so because they can never understand, nor accept an explanation.
That is so because they have some variant among the autism spectrum disorders (ASD). In
tertiary care I would say these make up a substantial proportion of patients (perhaps 1/10) that
gastroenterologists can never satisfy. But how many of the participating subjects do you think
might have had ASD?
3. In Discussion the authors write that “we showed” (line 237 and line 271). I think it is more
correct to say “we found”.
4. Reference 30 should read: Gastroenterology 2016;150 (6):1332–1343.
5. The whole concept of IBS is more or less a moving target. Among those we thought had IBS
in the early 1980’s nearly two thirds (2/3) have with time received other diagnoses (e.g. bile
acid diarrhea, microscopic colitis, celiac disease, various carbohydrate malabsorptive disorders,
exocrine pancreatic insufficiency, genetic aberrations and so on. IBS of today is still not a
homogenous group. It is much more likely that it consists of several smaller groups yet awaiting
diagnosis. The term IBS lump them together only on the basis of symptom similarities and
perhaps the fact that we don’t know what causes their symptoms. What is the impact (if any) of
our lack of knowledge with regard to patients’ need for "clear communication"?
Title: Patient preferences of healthcare delivery in irritable bowel syndrome: a focus group study
Version: 0 Date: 27 Sep 2021
Reviewer:  Greger Lindberg
Reviewer's report:
This is a qualitative study with focus groups of needs for patients with IBS. The authors claim
that multidisciplinary treatment teams, centers of expertise and clear communication are needed
for patients with IBS. Although I sympathize with the unique employment of focus groups for
identifying the needs of patients with IBS there are a couple of issues with the present study that
need clarification or amendments.
1. The concept “centers of expertise” is actually introduced by those performing the interviews.
Isn’t there an obvious risk for bias if you ask “How do you feel about centers of expertise for
IBS care?” and “Which type of healthcare givers would you like to be involved in IBS centers
of expertise?” Do you think centers of expertise would have come up had you not mentioned
them to the participants? Please discuss these matters. Apart from the bias, would you say that
all patients with IBS would benefit from IBS centers of expertise? See also item #2 below.
2. I am uncertain about the representativeness of the 24 subjects included in this study. To
begin with the proportion of people who fulfil the Rome-III or Rome-IV criteria for IBS is quite
substantial and somewhere between 10-20 %. However, the proportion of people who receive the
diagnosis of IBS in primary or secondary care amounts only to 1-2 %. All subjects in this study
had been diagnosed by a doctor, so the participants came from the smaller (1-2 %) population
of people with IBS-like symptoms. Those are the patients who actually seek medical advice
for their symptoms (but the majority do not). So this smaller group consists of those that seek
answers. Some of those, do so because they can never understand, nor accept an explanation.
That is so because they have some variant among the autism spectrum disorders (ASD). In
tertiary care I would say these make up a substantial proportion of patients (perhaps 1/10) that
gastroenterologists can never satisfy. But how many of the participating subjects do you think
might have had ASD?
3. In Discussion the authors write that “we showed” (line 237 and line 271). I think it is more
correct to say “we found”.
4. Reference 30 should read: Gastroenterology 2016;150 (6):1332–1343.
5. The whole concept of IBS is more or less a moving target. Among those we thought had IBS
in the early 1980’s nearly two thirds (2/3) have with time received other diagnoses (e.g. bile
acid diarrhea, microscopic colitis, celiac disease, various carbohydrate malabsorptive disorders,
exocrine pancreatic insufficiency, genetic aberrations and so on. IBS of today is still not a
homogenous group. It is much more likely that it consists of several smaller groups yet awaiting
diagnosis. The term IBS lump them together only on the basis of symptom similarities and
perhaps the fact that we don’t know what causes their symptoms. What is the impact (if any) of
our lack of knowledge with regard to patients’ need for "clear communication"?
Please review this paper.
user
Title: Patient preferences of healthcare delivery in irritable bowel syndrome: a focus group study
Version: 0 Date: 27 Sep 2021
Reviewer:  Greger Lindberg
Reviewer's report:
This is a qualitative study with focus groups of needs for patients with IBS. The authors claim
that multidisciplinary treatment teams, centers of expertise and clear communication are needed
for patients with IBS. Although I sympathize with the unique employment of focus groups for
identifying the needs of patients with IBS there are a couple of issues with the present study that
need clarification or amendments.
1. The concept “centers of expertise” is actually introduced by those performing the interviews.
Isn’t there an obvious risk for bias if you ask “How do you feel about centers of expertise for
IBS care?” and “Which type of healthcare givers would you like to be involved in IBS centers
of expertise?” Do you think centers of expertise would have come up had you not mentioned
them to the participants? Please discuss these matters. Apart from the bias, would you say that
all patients with IBS would benefit from IBS centers of expertise? See also item #2 below.
2. I am uncertain about the representativeness of the 24 subjects included in this study. To
begin with the proportion of people who fulfil the Rome-III or Rome-IV criteria for IBS is quite
substantial and somewhere between 10-20 %. However, the proportion of people who receive the
diagnosis of IBS in primary or secondary care amounts only to 1-2 %. All subjects in this study
had been diagnosed by a doctor, so the participants came from the smaller (1-2 %) population
of people with IBS-like symptoms. Those are the patients who actually seek medical advice
for their symptoms (but the majority do not). So this smaller group consists of those that seek
answers. Some of those, do so because they can never understand, nor accept an explanation.
That is so because they have some variant among the autism spectrum disorders (ASD). In
tertiary care I would say these make up a substantial proportion of patients (perhaps 1/10) that
gastroenterologists can never satisfy. But how many of the participating subjects do you think
might have had ASD?
3. In Discussion the authors write that “we showed” (line 237 and line 271). I think it is more
correct to say “we found”.
4. Reference 30 should read: Gastroenterology 2016;150 (6):1332–1343.
5. The whole concept of IBS is more or less a moving target. Among those we thought had IBS
in the early 1980’s nearly two thirds (2/3) have with time received other diagnoses (e.g. bile
acid diarrhea, microscopic colitis, celiac disease, various carbohydrate malabsorptive disorders,
exocrine pancreatic insufficiency, genetic aberrations and so on. IBS of today is still not a
homogenous group. It is much more likely that it consists of several smaller groups yet awaiting
diagnosis. The term IBS lump them together only on the basis of symptom similarities and
perhaps the fact that we don’t know what causes their symptoms. What is the impact (if any) of
our lack of knowledge with regard to patients’ need for "clear communication"?
assistant