Reviewer’ s report
Title: Factors Associated with Receipt of Mammogram among Caregivers: A Comparison with
Non-Caregivers
Version: 0Date: 18 May 2020
Reviewer's report:
This work examined factors influencing mammography screening, with particular comparison
between caregiving and noncaregiving women. Examining the impact of caregiving burden onhealth behaviors is an important focus for understanding caregiving needs and informinginitiatives to promote caregiver health as those needs are uncovered.
The title of this manuscript leads one to expect a focused examination of the role of caregiver load
on caregiver's seeking mammogram. However the methods include many potential contributingfactors beyond this, suggesting the scope is too broad and/or the title is inappropriate. Along theselines, the introduction is too long, and particularly because of the numerous list of factors offeredthat may impact ones seeking mammography. As more and more factors are presented, it becomesa "laundry list" of potential considerations that detracts from focus of this work. These may alignwith the planned analysis, but I recommend making sure any factors that are not being directlyevaluated in this study be removed from the introduction. Further, the initial paragraph of cancerstatistics could be shortened; not all of these statistics are relevant to this study's focus. Can moresuccinctly state that screening mammography contributes to early detection nd decreased mortalityof breast cancer, and then potential barriers caregivers may have to this.
The sample includes women 40-75 years, but cites recommendations that women age 45-55 have
yearly mammogram and then every other year after 55. These guidelines are further complicatedby other organizations suggesting otherwise (eg, shared decision making for individual guidelinefor women 40-49). therefore, age of sample is important, but not given enough attention insampling or in description. Due to lack of clarity of guidelines, this would be a cleanerexamination if it only sampled women 45+, or even 50+for an indication if people who havespecific guidelines for annual mammogram are seeking it. It is unclear the value of comparingcaregivers under 45, as their motivation for mammogram is likely different given the lack ofscreening guideline). At the very least, if these younger women are to be included, the sampleneeds to clarify the ranges of women (eg, how many women in each group were 40-45?). the rangeof the entire sample and the group means is insufficient given the importance of age on screeningguidelines. Further, this needs to be addressed in discussion.
the first paragraph of the discussion section addresses age briefly. however, it makes the leap that
age is associated with increased hospital visits for both groups. but again, age is also associatedwith different guidelines for mammography frequency. the explanation of increased hospitalexposure due to their own age seems a bit of a leap to be the only one offered.
The paragraph about hours offers a nice additional reference on this topic for comparison.
However, the explanation for variance between study results does not make sense." The possible explanation is that caregivers may have efficient opportunities to learn cancerhealth knowledge and to access to medical professionals [27]." wouldn't this have been the casefor caregivers in both studies? how does this explain why your caregivers might have beendifferent?
The discussion offers several "should" recommendations that are not supported by the study at
hand. For example, "Family-centered and community-based support should be enhanced to reduce
the burden of caregiving among middle-aged and older women caregivers and to promote
mammogram screening." This general statement lacks useful guidance and is not supported by thestudy.Further, the entire last paragraph addresses recommendations for reaching homebound caregivers,however the authors did not evaluate homeboundedness in their work, nor did they identify lack ofaccess to mammography as a contributing factor. this entire paragraph should be removed.
It is also recommended that this work be edited by an English speaking editor prior to
resubmission. There are several repeated errors (eg, capitalizing mammogram) as well asnumerous individual word choice and placement issues that if edited would ease readability andclarity.
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.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre 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.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively editedDeclaration of competing interests
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