Review for 10.1186/1471-230X-14-107 (2014)

Reviewer's report
Title:Clinical and Psychosocial Variables Associated with Behavioral Intentions
to Undergo Surveillance Endoscopy.
Version:3Date:24 February 2014
Reviewer: Massimiliano di Pietro
Reviewer's report:
Aims of the study
The authors attempt to tackle an important and understudied area pertaining to
endoscopic surveillance of Barrett’s oesophagus. Such a study has implications
for understanding the optimisation of patient engagement with Barrett’s
surveillance in a population in whom the diagnosis is known. These kinds of
studies also potentially address the wider questions of public engagement with
cancer prevention programmes.
Methods: To do this the authors ask patients who have agreed to undergo
endoscopic surveillance for confirmed Barrett's to fill out a questionnaire using
questions which are categorisable under 6 psychosocial factors which may have
influenced the decision to undergo endoscopy. The construction of the
questionnaire builds on previous studies that have used a similar questionnaire.
Overall the paper is well written. The authors explain terms to the reader, who
may not be familiar with psychosocial concepts, in a clear and simple manner
with reference to explanatory examples, which is refreshing.
Major Compulsory Revisions
1. The discussion of the results glosses over the major bias in the study which is
the 40% response rate for those approached. Clearly this has an impact on the
interpretation of the results so that the conclusions reflect the positive factors that
influence the decision to undergo Barrett’s surveillance. It would be important to
note that an important aspect of engaging with patients is understanding the
reasons why they do not want to undergo surveillance so that the study explains
only one half of the story and is not a full exploration of the ‘psychosocial
domains that predict intention to undergo Barrett’s surveillance’. The authors
should make this clear in their conclusion.
2. In relation to the previous point, it should be commented on the fact that
demographic diffrences between the population studied and the population that
opted out from the questionnaire can potentially affect the results. These could
be more difficult to generalize if the two populations differ. Are the author in
possession of any demographic data (like age and race at least) from the
population that opted out
3.The authors should also make it clear that their study population is much more
likely to be engaged with healthcare literature (predominantly white middle aged
male with 59.3% college education) and this engagement will impact on the
salience/coherence factor. Appreciating that Barrett’s populations share this
demographic the only problem with this is that the results are difficult to
generalise to surveillance in other cancers- this should be mentioned in the
conclusion.
Minor Essential Revisions
1. Figure 1 has no legend associated with it- just a title
2. Figure 1 uses the term ‘...Endoscopy for cancer screening/ surveillance’.
Oesophageal cancer screening is a very different topic and was not explored
here so this should be removed.
Discretionary Revisions
It would be useful to have a copy of the actual questions used in the
supplementary data.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'