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A patient-oriented research approach to assessing patients’ and primary care physicians’ opinions on trauma-informed care

Seint Kokokyi, Bridget Klest, Hannah Anstey

Abstract
To gather patients’ and primary care physicians’ (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors.

Introduction
Trauma-informed care (TIC) was developed based on research investigating service interventions for women survivors of violence with concurrent disorders [1] and has since been implemented in healthcare [2–5]. The Substance Abuse and Mental Health Administration (SAMHSA) described TIC as a framework that aims to understand and respond to the impact of trauma utilizing six key principles: 1) Safety, 2) Trustworthiness and Transparency, 3) Peer Support, 4) Collaboration and Mutuality, 5) Empowerment, Voice and Choice, and 6) Cultural, Historical, and Gender Issues [1]. There have been several reviews of TIC and its implications in the healthcare system [2–5]; however, there is variability in what is considered to constitute TIC in the provision of TIC training within the healthcare system, and in the literature discussing the need for TIC in healthcare practice.

Phase 1
To our knowledge, no research has assessed the opinions of both healthcare consumers (i.e., patients) and providers (i.e., physicians) on TIC. Further, among the research that has investigated the implementation of TIC, the importance of TIC to consumers and providers and whether or not TIC is already being practiced has not been assessed. In an effort to narrow this gap, the opinions of patients and PCPs on TIC were explored in Phase 1. The general population (patient sample, henceforth referred to as patients) and PCPs (physician sample, herein referred to as physicians) in Canada were surveyed regarding their perspectives on TIC.

Phase 2
In Phase 1 both patients and physicians rated TIC as important for patient care, but patients did not perceive receiving TIC at the same level that physicians perceived administering it. The research team met to discuss the results from Phase 1 and to share their own experiences with the healthcare system, as consumers, providers, and family members. From these discussions, recommendations were made to address this discrepancy.

General discussion
On average, patients and physicians in this study found TIC to be important. Patients reported receiving aspects of TIC service, but not nearly as frequently as physicians reported delivering them. While previous research has suggested that TIC may simply be good patient care given that its core components are safety, trust, collaboration, empowerment, and cultural sensitivity [46–48], TIC is unique as it involves understanding patients’ experiences through a trauma lens.

Acknowledgments:
Special thanks to Ms. Tracy Kydd, Dr. John Fryters, Mrs. Hannelore Fryters, Dr. Crystal Ferguson, and Mr. Emiolio Filomeno for their involvement throughout the research process.

Citation: Kokokyi S, Klest B, Anstey H (2021) A patient-oriented research approach to assessing patients’ and primary care physicians’ opinions on trauma-informed care. PLoS ONE 16(7): e0254266. https://doi.org/10.1371/journal.pone.0254266

Editor: April Joy Joy Damian, Johns Hopkins University Bloomberg School of Public Health, UNITED STATES

Received: September 2, 2020; Accepted: June 24, 2021; Published: July 9, 2021.

Copyright: © 2021 Kokokyi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: B.K. 3134 Saskatchewan Health Research Foundation https://www.shrf.ca/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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