Reviewer’ s report
Title: Bridging different realities - a qualitative study on patients experiences of preoperative care
for benign hysterectomy and opportunistic salpingectomy in Sweden
Version: 0Date: 17 Jul 2020
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs,supporting materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.This manuscript adds more information to the existing literature on the subject . After reading
through the manuscript though, I am not sure that the inclusion of the phrase: 'opportunisticsalpingectomy' is appropriate, since this was not significantly addressed by the responses from thesubjects. On page 4 and elsewhere, may I suggest that the term 'Hysterectomy' be used instead of'removal of the uterus?'. A lay person in the Western world is likely to know what 'hysterectomy'means, as would certainly everyone who will eventually read the paper when published.Although this was a qualitative study and numbers small, it would have been interesting to seehow the themes were differentially populated if the respondents had been clustered by 'indicationsfor hysterectomy'. For example a younger woman would have worried more about cessation ofmenses than a peri-menopausal woman. All women in whom hysterectomy was offered pre-emptively for early stage cancer would not think twice or even regret the decision.I suggest that the authors please describe the 'usual' or 'typical' management sequence from when
the need for hysterectomy is offered, until it actually gets done in the Swedish Medical setting.
This will help readers understand the patient's perspectives. Furthermore, it will be useful to stateif there is any practice guideline of Hysterectomy in the Swedish Medical system, and ifGynecologists are expected to adhere to the advice therein e.g. medical options exhausted beforesurgical, offer of options to patients after adequate information and education, referral to Patient-Family Educator on what to expect around the time of surgery. Patients are also encouraged toaccess Support Groups.The authors may want to consider the following additional points in their discussion: (1) thepatients' assumption that a hysterectomy without oophorectomy results in estrogen deprivation andthe attendant physiological and psychological symptoms (2) some patients' assumption that thereis no sexuality after hysterectomy. Maybe this has an indirect bearing to the comments of not'feeling like a woman'.It is clear that pre-operative information, communication and education towards hysterectomyneeds a little more work in Sweden, if the findings of this FGD study reflects a wider feeling andperception.
Publons Reviewer Recognition. Springer Nature can send verification of this review directly to
Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service,please click on the “Yes” option below. Your name, email address, title of the reviewed
manuscript, name of the journal, and date of your review submission (the “Review Data”) will
then be transmitted to Publons upon publication of the manuscript. If you have already registeredat Publons, they will notify you of the receipt of this review and update your profile as per yoursettings and their policy. If you are not registered with Publons, you will receive an email fromthem asking you to register in order for them to be able to recognize your review on your newprofile page. Publons may use the Review Data to generate derivative metadata for the benefit of
Publons and you as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile published on itswebservice if you have registered for such service or help editors to identify candidate reviewers.Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms
NoAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or 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.Reviewer Publication Consent. I agree for my report to be made available under an Open Access
Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completing
the review.If you wish, you can include your name in your published report. Please note you must
decide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.