Reviewer ’s report  
 
Title:  When a mother has cancer: Strains and resources of affected families from the mother's 
and father's perspective - A qualitative study  
 
Version: 1 Date: 19 Feb 2018 
 
Reviewer:  Eliza  Park 
 
Reviewer’s report:  
 
This is an exploratory qualitative study evaluating the burden of resources affected by a mothers' 
cancer diagno sis. I applaud the authors for furthering the science in an understudied topic of 
parenting with cancer and I look forward to their continued research on this topic.  However, I do 
have several major concerns about this manuscript.  
 
(1) This manuscript wo uld GREATLY benefit from the description or use of a conceptual model 
to frame the problem or explain the study findings. Otherwise, the manuscript feels somewhat 
unstructured and the discussion lacks focus. Is the unit of focus on mothers separately from 
fathers?  dyadic?  families as unit of analysis?  This needs to be clarified throughout text as well 
as in figure.  
 
(2) Examination of the data in family units (dyads) rather than separately as mothers vs fathers.  I 
suspect the richness of the data collec tion method undertaken would be greatly enhanced by 
evaluating the data in family units (eg mother -father dyads).   
 
(3) A major concern I have which is not so easily remediable: I have concerns that thematic 
saturation was not reached for the fathers data.   It is rare that thematic saturation is reached with 
10 participants for such a complex phenomenon.  
 
(4) No data reported with respect to cancer stage, functional limitations, or understanding of 
illness severity or with respect to mother/fathers' parenta l responsibilities pre -cancer. 
Presumably, impact on working parent whose primary responsibilities included financial income 
for family would be very different than parent whose primary responsibility was to raise the 
children and would impact saturation. Given the prevalence of same sex couples, do you think 
the results would differ if the co -parent were also women?  
 
(5) It would be helpful if the authors specifically described in the discussion section the ways 
that this manuscript adds to the existing lit erature base.  
 
(6) Do the authors know how the families in which the mother refused access to the fathers 
differed from those in which they did allow contact from the research team?  A potential source 
of bias would be that the families who are struggling m ore did not participate (particularly given 
mothers' concerns that the interview would add to the fathers' burden).  If there are socio -
demographic characteristics that differ between mothers who did and did not allow access to 
fathers, how might this chan ge interpretation of results?  
(7) Throughout the manuscript, there are several instances in which the use of the English 
language/grammar is incorrect/awkward.  At this stage, I would not consider the English written 
in a manner suitable for publication in  the journal.  
 
 
Minor:  
 
(1) In discussion section, the authors conclude the following about the fathers: "However, they 
were coping well and mainly mastering the situation."  This statement - while it might indeed be 
true -- is not necessarily demonstrated by the data.  IT is a broad statement. Can the authors 
specifically describe their justification for this?   
 
(2) Figure 1 still needs more work. Not clear how the different burden domains inter -relate  
 
(3) In Table 3 focusing on burden, authors report adjus tment of self -concept as father as a burden 
- however, not clear from the quote that the changes described necessarily represent "burden" per 
se; could also be interpreted as beneficial to family to have a new conceptualization of what it 
means to be a fat her.  In addition, "ways of coping" is not a burden per se either.  
 
 
Table 4 is helpful.   
 
I encourage the authors to enhance this manuscript and seek publication of their work!  
 
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 conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wri tten 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 financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain o r lose 
financially from the publication of this manuscript, either 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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