Both “Vitamin L for Life” and “One Milligram of Satan”: A Multi-Perspective Qualitative Exploration of Adjuvant Endocrine Therapy Use after Breast Cancer

Round 1

Reviewer 1 Report

 

I would ask the authors to modify the last statement of the Abstract, when they indicate that " Intervention components supporting AET use could include: provision of educational material (which may be necessary but insufficient)...". The data here analyzed can not be immediately become the component of interventions to improve adherence.

The same request for the Conclusion, when they indicate that "Recommended targets at the individual level include: considering information provision about AET necessary but insufficient alone, ..". Data here obtained can not be immediately converted into actions as they indicate. 

 

Author Response

Please see the attachment, comments 1-2 respond to your suggestions specifically. Thank you for your review.

Author Response File: Author Response.docx

Reviewer 2 Report

Both “vitamin L for life” and “one milligram of Satan”: A multi-perspective qualitative exploration of adjuvant endocrine therapy use after breast cancer

 

This is an interesting manuscript which I enjoy reading. The report is very well written and worth publishing. The Figure 1. Factors supporting adjuvant endocrine therapy use and potential interventions are especially useful for clinician researching in this area.

 

I have some minor comments

The title was inspired by one quote stated under “Rationale for use”:

One participant referred to her anastrozole as both  “one milligram of Satan” and “vitamin L… for life”, which captured a common sentiment that participants could simultaneously derive comfort from AET while suffering from its =I was wondering if this could reflect overall themes of the study? This might narrow the scope of the manuscript.

 

The work was aimed to investigate factors that support women in AET use

 

 

The 3 groups of participants were:

 

1. women who persisted with AET
2. women who discontinued AET
3. healthcare providers (HCPs; oncologists, oncology residents, and pharmacists
4.  

The second aim was to investigate suggestions for interventions to improve AET use and management. The 2^nd aim is not clear here. Which participant were going to discuss various intervention?

 

The purpose of this study is to understand factors associated with AET use and develop a deeper understanding about specific intervention components participants would find helpful in supporting AET use.

This study contributes to the literature in two important ways.

First, women who persisted with AET, women who discontinued AET, and  HCPs are included, providing the opportunity to compare viewpoints. = can this be achieved since there is a disparity of participants from each group? Did the author included the Kohen's Kappa: A Measure of Inter-Rater Reliability for Qualitative Research

Second, this study is designed to inform intervention development by explicitly asking participants what strategies helped them (or their patients) persist with AET, or what supports or resources they think would be/have been helpful. = I doubt the qualitative research should be used to identify this because we need further survey study to corroborate the identified themes.

 

Main themes identified (as stated below) are rather generic and well known, I was wondering what was the new and specific findings that are specific for the targeted disease and population group?

 

Stated in manuscript “Women who persisted described being prepared for side effects and having self-management strategies, strong rationale for AET use, supportive HCPs, and available resources as relevant factors. Women who discontinued described feeling overwhelmed by side effects, information needs, drawbacks of AET, helpful/unhelpful experiences with HCPs, and contextual factors as relevant to their discontinuation.

 

HCPs described health system-related and patient-related barriers, side effect management, and patient provider-interactions as relevant to supporting AET use.”

 

Abstract : further info on method should be included, including ethics approval, point of saturation, coding etc.

Table 5. Comparison of themes across groups=I reckon better presented as Coding tree for thematic analysis

Author Response

Please see the attachment, comments 3-10 respond to your suggestions specifically. Thank you for your review.

Author Response File: Author Response.docx

Reviewer 3 Report

This is a very well written and presented article. It was interesting and I enjoyed reading it. While a few qualitative studies have already been done in this area, this article validates previous findings and it also brings the added dimension of the HCP view. The comparative table across the 3 groups (persistent, non-persistent and HCPs) was of particular interest. Well done.

Author Response

Thank you very much for your review

Reviewer 4 Report

This is an interesting article on the qualitative assessment of the factors related to the adherence to endocrine therapy in breast cancer patients.

The conduct of study and the results are quite revealing, especially in the non-adherence group where most future efforts should be directed to.

With regards to the discussion and the limitations stated, I would like to see some reference to the health literacy level of the participants as this is a factor that is strongly associated with the ability to understand and to endorse systematic medication especially in chronic disease patients. In suggesting training and information sessions it would also be very interesting to include some suggestions with regards to the role of religious background of breast cancer patients Moreover, the quality of the online available resources and information is a parameter that needs to be discussed.

Finally, I suggest to remove the phrases in quotes from the title.

Author Response

Please see the attachment, comments 12-15 respond to your suggestions specifically. Thank you for your review.

Author Response File: Author Response.docx