Title: Perspectives on fertility preservation among women living with breast cancer in Ghana
Version: 4 Date: 07 Jun 2025
Reviewer:  Germanus Natuhwera
Reviewer's report:
Perspectives on fertility preservation among women living with breast cancer in Ghana
Well done to the authors of this work. The research was well designed, undertaken and reported,
and has relevant and promising findings.
Nonetheless, I do have comments for the authors which I feel need to be addressed to strengthen
the paper to publishable standard.
Methods
- The statement ‘We present qualitative data…’ is misplaced and could be revised. You do
not present data at this stage. The methods section describes how, who and when the data was
collected.
Results
- In the methods section, the authors state that they used thematic analysis. However, in the
results section, it is not clear how many and what were the main (and or/sub) themes that
emerged? Please amend the section and make this clear.
Introduction
- The authors use the term ‘clients’, I am not sure what this means or who it refers to? is it being
used to mean patients? it is good that the authors be consistent with descriptions to enhance the
clarity and readability of the paper.
- Otherwise, the introduction is very well written and lays an adequate (with good depth) context
for the back and is supported with appropriate and adequate literature. Well done.
Methods
- Study design: The authors mention that ‘The data used in this article is drawn from the
qualitative phase of a mixed method study’. However, the type of mixed methods design that
underpinned the larger study is not clear. Please clarify.
- Delete the sentence ‘using a semi-structured interview guide’ under the heading study design.
This would read well in the procedures section.
- Participants: the paragraph ‘Participants were interviewed using semi-structured interview
schedule guide that was specifically developed by the research team. This guide covered a range
of key topics, including the experience of living with breast cancer, treatment and fertility, as
well as knowledge on FP (See the supplementary file)’ is misplaced. This should be captured
under procedures heading.
Data analysis
- It is advisable to clarify the co-authors who undertook data analysis by use of initials of their
names in brackets.
- Drop the sentence ‘ The details of these themes are discussed in the next few sections’.
Results
- There are two headings ‘results’ and ‘finding’. I find that this I somehow confusing. Can the
heading ‘findings’ be revised to: themes?
- Table 1: Last column (children). This is not clear, what is this about? Number of children bared
or? Please clarify.
- Could revise column 2 (identity) from ‘patient’ to participant so that it reads as: participant
1, participant 2…
- Page 10, last paragraph, the word ‘instructive’ is confusing in the sentence. Could revise to
make clear.
- What do abbreviations ‘JHS’ and ‘SHS’ mean? These appear in the table for the first time but
they are not defined nor is a legend explaining them provided.
Table 2: I wonder whether theme 1 really does/did not have subthemes or codes/categories. I
can see the section is blank.
Themes
- I would advise that the authors drop age and year in the quotes and rather report only codes/
identity of participants.
- I think the authors need to try to quantify some of the narratives to enhance the clarity of
the results section. For example, whey they say ‘Most women in this study indicated a lack
of awareness regarding FP’ the reader keeps wondering what fraction or percentage of the
participants were these (most)?
Discussion
- I find that the discussion is well written and sits well with existing literature about the topic. The
strengths and limitations of the study are well written and are consistent with the study findings.
- The conclusion statement could be improved to highlight key takeaway message for the reader
as supported by study findings. Whereas the conclusion statement in the abstract section is very
clear and strong (speaks to the key findings of the research), the conclusion statement needs
polishing to align well with the key findings of the paper..
- The word ‘client’ is used again. This term is confusing and in sections where it has been used,
it obscures the clarity and readability of the paper as it’s not well defined. It is not clear what
it means.
Ethics statement
- Please clarify the nature of informed consent obtained. Was it written or verbal consent or both?