Reviewer's report
Title:Frequency Format Diagram and Probability Chart for Breast Cancer Risk
Communication: a Prospective, Randomized Trial
Version: 1Date:11 June 2008
Reviewer: Claire Julian-Reynier
Reviewer's report:
Major Compulsory revisions
Introduction:
In this manuscript is considered only “risk knowledge”. Risk perception is a more
global concept that directly influences health behavior whereas risk knowledge
does not directly. Referring to the literature in a more comprehensive, cautious
and precise way would be welcome.
The objective to look at the impact of the intervention on risk knowledge appears
to be a reliable one. Looking how it affected decision making regarding risk
reduction strategies or how it affected patient satisfaction is not for the following
reasons.
1) Only before-after consultation declarative data have been collected (with no
clear measurement of behavior)
2) The sample seems not particularly well targeted for risk reducing surgery
strategies and too much homogeneous for the other preventive options described
(Table 3: previsit: 97% have regular follow-up, 0% medication)
3) The scale used for measuring satisfaction (only one item with a four item likert
scale for the answer) is not sensitive enough to assess an eventual change in
satisfaction. Specific satisfaction scales have to be used to achieve this goal in a
reliable way.
Methods
If there was stratification on age and block- randomization, it seems necessary to
adjust the statistical analysis and the presentation of the results to this method. If
this has been done it should be precised in the paragraph on statistical analysis.
It is not clear from the text to understand how the intervention has been provided:
was the document discussed or not during the provider’s encounter? It seems
not to be a blinded trial therefore an allocation bias could have occurred: how did
you manage to control for it? How were providers’ oral explanations on breast
cancer risk controlled? Was it possible to control (or at least to know) for oral
communication of frequency format in both groups?
Results
Figure 3 , 4, are not understandable; please clarify.
Discussion
Give references for your first statement on the fact that “accurate understanding
of risk most likely affects adherence to recommendations for breast cancer
screening…. Etc.”
Give more input for the main limitation of the study which is the very short
follow-up. What about the literature on cancer genetic consultations? You
mentioned only “educational visit”. Please justify. Discuss also the issue of oral
information allocation bias (if the provider was aware of the randomized group).
I clearly think you should delete all the text corresponding to women’s choice of
risk reduction strategies and satisfaction (cf remarks above)and synthethize on
the impact on risk knowledge only.
Minor essential revisions
Abstract:
Conclusions: modify “can improve the accuracy” by “can improve short term
accuracy”. Last sentence is not a conclusion of this study and should be deleted.
Methods
Inclusion criteria: could you precise whether affected and healthy unaffected
women were included? And on which time period? What was the participation
rate?
Where has been completed the post-visit questionnaire?
It is necessary to explain what is considered to be “accuracy” of risk perception.
Results
Adjust the presentation of the results to the stratified design (it seems that mean
age +/- what: SD? Please precise) is not relevant if there was a stratification on
age).
Table 1: precise n % (also for table 2)
What is y ? (ist line)
Professional
Gail risk score categories: 50% and over?
No interest of “Atypia” in the table
Table 2: it would have been informative to know how many could not give a
number before and after. How stratification has been considered in the analysis?
Table 4: delete
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests' below