Review for 10.1186/s12876-015-0356-5 (2015)

Reviewer's report
Title:Patient-centered factors associated with hepatitis C treatment: a qualitative
study
Version:4Date:21 July 2015
Reviewer: Sheryl Szeinbach
Reviewer's report:
The manuscript is somewhat improved. However, there are still issues that need
to be addressed. In summary, this preliminary study is an excellent starting point
from which the content can be condensed and included in a future study that is
larger and more rigorous.
Major:
General use of the word “factor” is fine when referring to studies other than
psychometric-based studies. However, this is a psychometric-based study.
Typically in these studies, use of the word “factor” refers to a quantitative
approach for data reduction, reliability, and validation of measures. A quantitative
approach was not used in this study. Thus, the title of the manuscript appears as
if a factor analysis (quantitative analysis) was performed when it was not. Adding
to the confusion is the use of the word “qualitative study” in the title. Strongly
suggest changing the title to reflect the main purpose of the study – and
removing the word factor in the title and throughout the text.
Possible suggestions for title: Qualitative analysis of patient perceptions of HCV
treatment: Developing a shared decision-making aid to initiate therapy in patients
with chronic HCV;
Developing a shared decision-making aid to optimize HCV treatment….: A
qualitative analysis of patient perceptions
Line 108 & 109 …. “For the purposes of this paper, we define a factor as an
influence that contributes to an outcome, such as a decision (e.g., a decision
regarding treatment).” No, the information contributing to patient outcomes is
patient perceptions of treatment as gleaned from the interviews. Patient
perceptions influence the outcome, that is, his or her decision to not undergo/not
undergo therapy, which is accomplished in conjunction with input from the
prescriber. Hence the major reason for developing this shared decision-making
aid. Figure 1 is a conceptual framework, which is a graphical depiction of
variables, themes, concepts and the purported interrelationship between these
measures. Please see HM Blalock. How variables are operationalized should be
explained in the methodology.
In addition, if a data reduction technique was not used, then use of the word
“factor” also implies that a rigorous format was used to assess reliability and
validity. Neither reliability nor validity was addressed in the study design or for the
data collected in the study. If measures are not reliable or valid, their usefulness
to clinicians and other researchers is minimal.
Line 175. “As coding progressed, factors were compared and integrated into
broader categorical factor labels.” No, using axial coding, single words or items,
and phases were compared and grouped into respective themes or categories.
The method section needs to be clearer. Thus, for the future analysis, all the
items (X1, X2, X3, etc..) that comprise each theme or category (i.e., construct or
factor in the actual quantitative analysis) would hopefully group together in a
future factor analysis, which at that point, the emerging theme becomes that
factor or construct labeled according to the item with the highest loading. Hence
use the word theme to describe the group of items that fit together or the major
headings (categories) that emerge – as presented in the saturation grid. Please
think about the future analysis when designing the aid. How would the variables
presented in Figure 1 fit into the shared decision-making aid so that data could
be extracted from the aid and analyzed?
The investigators discuss new therapies in the introduction, which are purported
to have fewer side effects, yet side effects were perceived as the most salient
theme by patients. Is there an explanation for this observation?
As I read this manuscript, the purpose of this study appears to be to develop this
shared decision-making aid, tool or instrument for chronic HCV treatment. This
purpose as currently presented and how it relates to shared decision making are
not clear. For example, for the discussion and to connect with the content in the
introduction: …with shared decision making, a concerted effort between
providers and patients can optimize therapy and perhaps convince patients who
are avoiding therapy to initiate therapy, especially given the possible perception
of some patients who may have derived their views from side effects noted with
the older interferon-based treatments of HCV. The shared decision-making aid
also serves to educate patients who may not be informed (as mentioned in the
introduction) of the newer direct-acting agents and the predilection of these
agents to have fewer side effects.
Introduction: To accomplish the goal of developing this aid, investigators need to
identify patient perceptions of these treatment options (i.e., now, never, thinking
about it) in the management of chronic HCV. Researchers followed a standard
procedure – grounded theory, psychometrics – establishing the reliability and
validity of measures. Thus, the framework provided in Figure 1 should be
“Saturation grid: Themes considered in the development of the shared
decision-making aid…..” The investigators should also provide a draft or
complete version of this shared decision-making aid in the Appendix. Not being
able to do so would suggest that additional data are needed.
The content of the abstract is vague and fails to “connect the dots” in this study.
For example, how is the information presented in the background section
connected to shared decision making or the development of the shared decision
making aid?
As is, the conceptual framework is still not testable and does not adequately align
with research findings and the purported purpose of the research. The framework
should be rearranged and presented as a recursive model; this is a decision
process leading to an outcome. As I understand the goals of this study; the DV
appears to be “the treatment decision” or “decision to initiate therapy,” etc…
Please check and reference other studies that already support the emergence of
the themes presented in this study. This information would help validate the
study findings and guide researchers in the development of future studies.
The research idea is excellent and the preliminary information is promising for
the development of future and well-designed studies.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
Already stated --