Title: WOMEN'S EXPERIENCES WITH BREAST CANCER DURING DIAGNOSIS AND
THERAPY, WOLAITA, ETHIOPIA: A QUALITATIVE STUDY
Version: 2 Date: 11 Dec 2023
Reviewer:  Chinomso Ugochukwu Nwozichi
Reviewer's report:
Thank you for giving me the opportunity to review this manuscript.
Below are my review comments:
- The abstract looks good. However, if the word count limit is not exceeded, you may include e
more information in the methods section of the abstract. For example, what sampling technique
did you use to recruit the participants? What did you use for the data analysis?
- You should sum up your main points and recommendations in a brief and clearly expressed
manner. - Your keywords should align with the journal’s guidelines.
- Please provide some more background information on the magnitude of this problem globally,
in East Africa and then in Ethiopia.
- Generally, the background of this study needs to be improved to justify the need for this study.
There are a plethora of studies on self-care among persons with enterostomy, so you need to tell
your readers what new information this study would add to the body of knowledge.
- I am wondering the significance of the fourth paragraph of the introduction between lines
62 to 71 where you mentioned that “The Ethiopian Minister of Health is constructing seven
radiology centers across the country in response to alarming trends in cancer prevalence and
incidence, as well as a massive backlog of cancer patients awaiting treatment across the country.
The Jima University Hospital opened Ethiopia's second radiology center, which was previously
exclusively provided at the Black Lion Specialty Hospital”. Does this information have anything
to do with the experiences of women during diagnosis and treatment? If yes, the you must tease
it out to contextualize the problem and research gap.
- Also, you already identified that patients with breast cancer have physical, emotional and
social changes including issues of threat to feminity, bodily pain, loss of hair and depressive
symptoms. The question remains why did you conduct this study other than the fact that there
no enough studies onthis topic in Ethiopia?  There are plethoral of literature on this topic in
Africa and globally? Why do you think these findings may not apply to your present setting?
Any contextual issues that really warranted this study? Are the experiences of women with breat
cancer in Ethipia different from those in other East African countries?
- The statement on line 88-91 is not clear “Nevertheless, in Ethiopia, rather than opening
screening and follow-up centres, particularly in the study area, the experiences of women with
breast cancer, the obstacles they confront throughout treatment and follow-up, and the forms
of care available to aid them have not been adequately examined” Please re-write for better
understanding.
- - What philosophical or theoretical structure underpinned this study? You need to show, in clear
terms, how a theoretical and/or philosophical position informed your study. - This manuscript
will benefit from a professional manuscript editing service.
- - The method section of this manuscript does not provide enough information as recommended
by the COREQ guidelines. See Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting
qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual
Health Care. 2007;19(6):349-357
- Who translated the transcript? What quality control measure did you put in place to ensure the
translation was accurate?
- It is not enough to generate themes  and subthemes from patient’s responses. You should
be  concerned with revealing the “essence” or “essential structure” of any phenomenon under
investigation – that is, those features that make it what it is, rather than something else.
- How did you ensure rigor in this study?
- Please provide more information on how you selected the participants? I am concerned that data
from just 10 participants may not necessarily represent the experiences of all cancer patients in
Ethiopia. Why did you select only 10 women? At what point did you reach saturation? Was your
analysis concurrently done during the period of data collection or you completed the interviews
before starting the analysis? How did you determine when to stop the interview? Please justify.
- Your discussion should address your significant findings and put them in context. For example,
the participants expressed hope in God and believed God would hel the. It would be best to share
more about the Ethiopian people's general value system and worldviews. This participant did
not just express hope, but their hopes were anchored in their belief in a supreme being or deity.
Is every aspect of life in Ethiopia viewed from a supernatural perspective? Does this affect their
understanding of the cause of cancer?
- The fourth theme and last subtheme talked about care and support, but you only presented
information only about the support provided by healthcare professionals. Did you find
information about social support from family and friends? How does this finding correlate with
the social structure dimensions in Ethiopia? Do patients cherish family presence during the
illness period?
- I do not see your recommendations. Your recommendations should be based on the specific
findings of this study. For example, women from your study expressed shame after losing a
breast to breast cancer. Do you think breast reconstruction surgeries would be an acceptable
option? If yes or no, why?
- I do not think studying only breast cancer patients is a valid point to be included as a limitation
since that’s what your study is about. However, before mentioning that the small sample size
was a limitation, you must explain how you attempted to address it and couldn’t
- Why, in the implications of the study, is there not mouch focus on how to best care for the
patient, given the importance of their worldview and the purpose of the study?
- I think it would strengthen this work to identify the researchers' positionality and bias in this
process.
- Thanks for this vital work! You did a lot of wonderful work and are establishing a manuscript
to improve the experience of women with breast cancer in Ethiopia.