Reviewer ’s report  
Title: Impediments to communication and relationships between  infertility care providers and 
patients  
 
Version: 0 Date: 25 Jan 2017  
 
Reviewer: Carolyn Ells  
 
Reviewer's report:  
Review of BMWH -D-16-00344  
 
This is an interesting report of an empirical study that used qualitative methods to explore 
questions about challenges health professionals may experience in providing care  to patients in 
conjunction with assisted reproductive technologies. A version of this paper would be interesting 
to publish and fill a gap in the literature. However, some revisions should be required.   
 
Of greatest concern to me is clarifying the role o f "patient -centered care" (PCC) in this work. 
e.g., Is it a background theory that permeates motivation, interview questions, and/or analysis?  
A preoccupation of participants interviewed? A preoccupation of author/researcher? Did 
participants use the term  PCC? Or did author/researcher choose this term to apply to the results 
of the research? I notice that the sample questions provided from the semi -structured interview 
do not use this term. They use more general language about challenges or obstacles in ca ring for 
patient, or communicating with patients. None of the quotes provided use this term. Did research 
participants know that the researcher was particularly interesting in PCC? Did they know what 
the researcher means by PCC?  
 
PCC is not defined or desc ribed in enough detail, in light of its role in the paper. Given the 
importance it has in motivating the research, it needs to be set out clearly in the first section of 
the paper. If it is a theoretical commitment that pervades the methodology, then it ma y be 
appropriate to set it out in more detail in the methods section (including how it is used to draft 
interview questions (if it is) and interpret responses (if it is)).  
Please provide a clear research question, or objectives.  
 
It is disturbing that t he author did not blind the paper sufficiently. Page 6, line 44 links the 37 
participant interviews to other published work that is not blinded (works cited 16 and 17). Table 
1 minimally describes the sample and was also printed in ref 16 and is what is pr ovided as the 
supplemental material of ref 17. Neither the articles (ref 16 and 17) nor their supplemental online 
material add new information about the methods or participant sample. None provide the 
interview guide.  
 
The failure to blind ref 16 and 17 r eveals that references 11 -17 are all by the author. These 
publications are all referenced in the Methods section on page 6. I looked up several of those 
articles. Pointing readers to these papers does not add substantially to an explanation of methods. 
They appear to be listed to pad the author's citation statistics. Better to explain and justify 
methods used so that readers could duplicate the procedures.  
 
Note that page 6 lines 12 -14 claim that the methods "adapted elements from "Grounded Theory". 
What w as adapted and why should be explained and justified. There is a statement on some of 
what grounded theory involves, but it isn't clear what procedures or commitments to the theory 
were followed in this study.  
 
Page 6, line 4, name missing.  
 
Page 6, secti on on Participants - This section includes recruitment, some methods (telephone 
interview), and not much about the participants themselves (beyond numbers of the type of 
health provider or a patient or both).   
 
Page 11, line 53, mentions patient -centeredn ess of office staff. Explain (perhaps earlier when 
unpacking what PCC means).  
 
The Results section seems to include a lot of commentary from the author. It should be made 
clear for the reader, what data comes from the participants and what from the author . The 
author's additions should be moved to the discussion.  
 
I expected the Discussion section to explicitly circle back to the themes raised (and references 
cited) at the beginning of the paper.  
 
Throughout the paper, facts should be supported by references. For example, page 25, line 25 
provides statistics that are not referenced. See also page 25, lines 49 and 57; page 27 line 6.   
 
Page 25, line 39, word missing.  
 
Page 27, lines 31 and 49, wron g words.  
 
Overall impression: Interesting study. Improvements should be made to the manuscript prior to 
publication.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
Are the conclusio ns drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Unable to assess  
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript : 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that  may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, eith er now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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I agree to the open peer review policy of the journal