Title: “I'm walking on eggshells”: Challenges faced by mothers with breast cancer in interacting
with adolescent daughters
Version: 6 Date: 16 Apr 2022
Reviewer's report:
This manuscript describes a qualitative study of breast cancer survivors, exploring the cancer-
related challenges they face with their adolescent daughters. This is an important area of
research, and the study highlights some interesting aspects of the relationship, however I have
some significant concerns about the methods and comments regarding the manuscript overall.
Major concerns:
1. Overall, this manuscript requires further English language editing and does not meet journal
criteria as written, in my opinion. This is especially important because the study explores a very
complex and nuanced topic, and the language needs to be precise to capture those elements of the
results and to adequately describe interpretation of those findings. For example, there are several
incorrect/awkward word choices throughout the manuscript, grammatical errors, inconsistent
use of verb tense, and some missing words.
Methods:
2. The analysis approach is unclear. The authors mention Foucauldian discourse approach
alongside a phenomenological approach. They also state that thematic analysis was used. Please
explain more about this as an analytic method and how it was implemented in this study. It would
also strengthen the manuscript to provide a clear research question that guided the analysis.
3. Participants: How was a purposeful sample obtained (i.e., how did the recruitment methods
facilitate that? What were the characteristics that you hoped to have represented in the sample?)
When was the data collection done (months/years)? How many refusals/non-participants were
there?
Regarding the sample size, what specific criteria were used to determine “no new themes
emerged from interviews”? Were data analyzed as they were collected? Please be more specific
about how you determined the point of saturation and sufficient sample size to answer your
research question. This article may be useful: https://pubmed.ncbi.nlm.nih.gov/34785096/
4. Procedure/Data Analysis: What were the interviewer characteristics/training? How was the
interview guide developed (e.g., based on literature review? Prior research?) Please provide
more detailed about the procedures for coding data.
Table 3 seems unnecessary. Following Braun & Clark’s thematic analysis approach, there is no
need for a frequency count related to codes or themes.
Overall, I recommend reviewing the COREQ checklist to ensure inclusion of important details
in this and other sections of the manuscript. As described, the methods do not indicate qualitative
rigor.
Results:
5. Be careful when describing themes/results not to use language that suggests you are
interpreting the results (which belongs in the discussion). For example, in theme 2.2, the
manuscript says, “Being a mother- including activities such as volunteering at their daughters’
school, going on field trips, and driving… is a difficult task for those with breast cancer,
especially those whose daughters are minors.” This could be reworded to state that participants
in this study reported that activities such as …. were difficult for them (vs. an overall conclusion
about how mothers in general feel).
Discussion:
8. The discussion needs further development for clarity and focus, some of which may be
improved with professional English language editing. The discussion does cover important
points and considers other research on the topic, but would benefit from more clear organization
around key points, synthesis, and interpretation of those findings (with careful consideration
to the limits of what can be concluded from a qualitative study such as this). In some
places, recommendations are made without evidence. Because the focus is on mother-daughter
interactions, it would strengthen the discussion to focus on that topic, and how communication
could be improved rather than with health practitioners can do. For example, are there resources
to support mother-daughter communication after breast cancer? What are some important
considerations for such resources/programs based on your results?