Reviewer's report
Title:Symptom Interpretation and Health Care Seeking in Ovarian Cancer
Version: 1Date:24 January 2011
Reviewer: Mairin O'Mahony
Reviewer's report:
- Minor Essential Revisions
Abstract
Methods: needs editing – could be written more clearly.
Conclusion: what does “medical cases” mean?
The last two sentences need to be linked better ie: Why must delay be
addressed from these levels?
Background:
Paragraph 2. Include Reference for Danish women and highest mortality rate.
Last line: this “study” (as opposed to this article)
The last sentence needs editing perhaps it could read:
“This paper reports a mixed method study on the health seeking and symptom
interpretation process of women who were diagnosed with ovarian cancer.
Methods
Perhaps edit to read “These results are combined with findings from interviews
with women on their bodily experiences with symptom development”.
Registry data and statistics
Line 4 : explain term IDs
Last sentence: Identify that this material is outlined in tables (Table 1 and table
2).
Overall, this section needs to be presented more clearly- currently it is very
ambiguous to read.
Interview Findings and analyses-
It is customary to describe data analysis first followed by presentation of findings.
The last sentence is unclear. Use of flow chart might be beneficial to explain the
process better.
Ethics and consent
I would suggest using another word for “pursuant e.g. “in keeping with”
Last sentence: change “approvals” to “approval”
Results
Paragraphs 1& 2: – this material could be presented in a more reader friendly
way- inclusion of per-centages and range when reporting results would assist in
this regard.
Referral to hospital services
This paragraph needs editing to read clearer.
Line 6-8 in particular is difficult to read.
Use of (n=) would be helpful when identifying the numbers of women in the
various categories.
Symptom development in a patient perspective;
Suggest change to “Symptom development: the woman’s perspective:
It may be better to refer to interviewees as “women” or “participants” throughout
the report. Be consistent in use of terminology (ie use one or the other).
Paragraph 1: First sentence maybe changed to read:
“Interviews were conducted pre-operatively (n=10) and post-operatively (n=9)
Paragraph 2: Insert “the” – see last sentence.
General Comment: Flow chart is very good but findings need expansion to truly
reflect women’s experiences.
Discussion
Second paragraph:
Line 3: change material to “data”
Line 7: clarify sentence re British rate and inadequate results- unclear – what is
meant here?
Line 10: edit this sentence underlined should read “highlighted” also clarify
procedures and pathways for what?
Line 12: suggest replacing “the possibility cannot be rejected” with “It cannot be
denied”. In addition , the next two sentences are unclear.
Symptom development in a patient perspective:
Suggest change to Symptom development: the patient’s perspective or the
woman’s perspective.
Paragraph One
Line 3: change to “Informant no 3 and her family”
Lines 6 & 7: edit: insert full stop after eliminated and start new sentence: ie The
results………therefore, recall bias could not be eliminated.
Line 7: change “in” to “on” patient delay….
Line 10: change “retrieved” to “highlighted”
Line 11: suggest change “patients” to “women”
Line 13: insert full stop after interviews and start new sentence: In the …..
Line 18: edit to “This woman reported….
Lines 18 &19: The sentence “intuitively she exploited her education level and her
position in society” needs clarification, as it suggests that the woman took
advantage of her education and position in society in an exploitive way.
The impact of social status
Study findings need to be clarified and compared to relevant literature in a more
coherent fashion. The section needs to come to a logical conclusion and reiterate
how this study adds to the current body of literature on the topic.
Conclusion
The structure and presentation needs to be edited to reflect that used in most
journals, where the conclusion is written in a more focused and succinct way.
I would suggest starting with the last paragraph ie: “ Diagnostic delay…….” and
incorporate the other material ie medical/organisational/ cultural/ social into the
text accordingly (delete headings), so that the conclusion reads like one
paragraph as opposed to using separate headings which tends to fragment the
content.
Last paragraph: Review Line 2: starting with “At present”: this sentence is
unclear.
Social
Edit “superior” to “higher” socio-economic status.
- Major Compulsory Revisions
1. Expand on qualitative data analysis, demonstrating how a
phenomenological-hermeneutic method was applied using
relevant literature to support ideas ie explain how data
were analysed to produce findings (Figure 1).
2. Although findings in relation to women’s experiences are
very well detailed in Figure one, they need to be
incorporated more into the section on “Symptom
development the patient perspective” to explain the
reality of women’s experiences.
3. Overall, Conclusion needs to be more focused and main
points better integrated ( see guidelines given)
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.