Reviewer's report
Title:Satisfaction and quality of life in women who undergo breast surgery: a
qualitative study
Version: 1Date:13 October 2008
Reviewer: Sophie Staniszewska
Reviewer's report:
MS: 8686414962125173
Research article
Satisfaction and quality of life in women who undergo breast surgery: a
qualitative study Anne F Klassen, Andrea L Pusic, Amie Scott, Jennifer Klok and
Stefan J Cano BMC Women's Health
This is a very interesting paper in an important area of work. I have some
comments which I hope will help to strengthen the paper.
One key issue which needs to be discussed in the paper is the nature of the
concept of satisfaction. In the UK setting it is now widely acknowledged that
satisfaction as a concept is not adequate in assessing the quality of care that a
patient may receive. In many respects it is probably a better measure of some
form of gratefulness and certainly is a poor way of capturing more negative
experiences of health and care. I wondered whether the authors had considered
this and maybe could include some thoughts on how this may impact on their
work. It is possible that in Canada this concept does have some currency but this
suggests that the cross-cultural use of such a tool to countries such as the UK
may be limited.
While the aim of the study was to develop a measure of patient-reported
outcomes and the study used a very traditional approach, I wondered to what
extent the women involved has influenced the dimensions identified, beyond
being sources of data as interviewees. In the UK context there is an increasing
movement toward more collaborative forms of research with individuals more
actively involved in studies, although it is less common in quality of life/PROMS
research. However some patients groups are starting to highlight the limitations
of patient-reported outcomes by claiming they do not reflect the areas of
relevance for them, despite extensive evidence of content validity. The patient
groups appear to be identifying issues that move beyond the focus that PROMS
often have. Some discussion of the level of involvement might be helpful even
though the study may not have approached the subject in this way. For example
it might be helpful to know the outcomes of the two focus groups where the
researchers took their ideas back to research participants. It would be very
helpful to have some of this data presented, particularly around the changes the
team made to the dimensions/items based on those groups. At the moment there
is a large debate around impact of user involvement in many aspects of research
and it really helps if authors can be as specific as possible about the impact or
different this input makes to the study.
It would be helpful to know how well the interview schedule worked in enabling
the women to tell their story. The schedule suggest possibly fixed ideas about
what the content of the interview might be, so it would be helpful to have
reassurance that women were able to talk about a range of aspects relevant to
them.
In page 4 the authors say that 51.7% of women signed a consent form and that
48 women took part. I am assuming that all of the 48 signed the consent form –
would help to make that clearer.
While there is obviously a word limit it would have been helpful to include more
quotations to get a better sense of how the data links to the category being
suggested as this is not always clear from the small amount of data here. While I
do recognise the limitations of publishing, as the study includes women form
three different samples I am concerned that it is hard to build up a picture of the
issues from these three perspectives.
The last of the categories presented – satisfaction with the process of care –
seems like a relatively limited category in that this is an enormous concept and
would normally be measured by a range of dimensions rather than just one. It
would be helpful for the authors to address this concern alongside that of a
concern around the nature of the concept of satisfaction.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests