Title: Perceived social support and coping style as mediators between resilience and health-
related quality of life in women newly diagnosed with breast cancer: A cross-sectional study
Version: 0 Date: 28 Mar 2022
Reviewer's report:
Thank you for the opportunity to review your manuscript. This study aims to examine the
mediator roles of PSS and CS in the relationship between resilience and HRQoL in women newly
diagnosed with breast cancer, which will provide new evidence for a multimodal intervention
program focusing on PSS and CS. Overall, I think the article has the potential to make a useful
contribution. I have made a few suggestions below which I hope will improve the readers’
understanding of your study.
Abstract:
1. “SEM analysis showed resilience had significant direct effects on PSS ... and HRQoL (B range
from 0.54- 0.58)”. The HRQoL B values shown in the results section are not the same as the
data shown in Figure 2 (B range from 0.44-0.63). Please double-check and correct the results.
Background:
1. The Background does not build a logical statement. When the variable is mentioned for the
first time, the concept of the variable should be defined as well as the impact, etc. For example,
HRQoL is mentioned in the first paragraph, but the concept is defined in the third paragraph.
PSS and CS are also key concepts in this study, but they are not defined.
2. What are the necessity and importance of selecting these variables (i.e., HRQoL, resilience, CS
and PSS)? For example, please further elucidate the effect of resilience on HRQoL and women
newly diagnosed with breast cancer. And please further elucidate the reasons for examining
mediator roles of PSS and CS in the relationship between resilience and HRQoL. The arguments
of “limited studies” or “a lack of research evidence ” are not convincing in all these cases.
3. The study used the NSM as the theoretical basis to build an influencing factor model. Please
clearly state the applicability and guideline of this theory to this study, rather than “few studies
are using this theory”.
4. The study population was women newly diagnosed with breast cancer, but the manuscript
lacked to explain the reasons for focusing on this population, and did not indicate the
characteristics and how it differs from the general breast cancer patients. For example, women
newly diagnosed with breast cancer lack adaptation and coping experience.
Methods:
1. Please present the number of items for each subscale of the 4 scales. The number of items
for the subscales varies, but the dimensions are calculated as the sum of the items scores, which
may create trouble for the reader in interpreting the results. For example, the highest BCS score
in FACT-Bv4.0 may be related to its highest number of items, and it is not necessarily the case
that patients perform best in this dimension.
2. Table 2 demonstrates that the corresponding norms choices for both CD-RISC and MSPSS
are adapted from the nurse population, which is a special group that has better resilience and
perceived support. Different corresponding norms will affect the results. Please choose the
corresponding norms from a more general group.
Discussion:
1. The overall discussion is not in-depth and logical enough. Please consider the clinical
implications of the findings and what could be done next. And each result should be
discussed completely before discussing the next result. Results, discussion, interpretation, and
recommendation should correspond to unity.
2. The results of each dimension of the scale are mostly explained by “consistent with other
studies”. Please discuss in-depth the reasons for the results, such as what manifestations and
characteristics of women newly diagnosed with breast cancer would lead to such scale results.
3. Paragraphs 2 and 3 both discuss HRQoL, and please combine them.
4. In paragraph 5, the interpretation of the result that “the avoidance CS did not significantly
influence HRQoL” is explained as “this may be because newly diagnosed patients chose the
confrontation CS to deal with their health problems, as the confrontation CS score is closer to
that of the norm.” However, according to the subscale scores and compared to the norm, there
are also many patients who choose avoidance CS. Is it possible to consider that avoidance CS
does not have a negative impact on HRQoL because it is preliminary protection for oneself to
avoid psychological trauma temporarily until one is prepared in the face of a life event shock
such as being newly diagnosed with breast cancer?