Psychological Determinants of Men’s Adherence to Cascade Screening for BRCA1/2

Round 1

Reviewer 1 Report

Overall, it is an interesting paper that tries to highlight different aspects of the management of potentially oncological patients. Moreover, the Authors take under consideration mainly the psychological point of view of these individuals and finally they further note the importance of the education of the individuals.

Please note that the above corrections must be proceeded:

line 30: double dot.

line 57: missing citation/reference

lines 89-92: add citation/reference

lines 100-109: re-phrase the sentences in order to be clear enough that the sentences below are Hypothesis. 

lines 111-113: re-phrase the research question. The answer could not be yes or no.

lines 114-117: this is not a research question. Re-phrase is needed. 

Additionally, cronbach a for intention and planning < 0.7 or 0.8. Comment on this.

Since the questionnaire is not standardized, a preliminary pilot study is crucial. Please comment on this. Provide the cronbach a for the questionnaire in total? In order to further evaluate the internal consistency of the questionnaire. 

 

Author Response

Please see the attachment.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors should be congratulated for their great work. The topic is interesting and challenging and it offers a new perspective for cascade screening for BRCA1/2 germline mutations.  This study analyzes psychological determinants of men’s adherence to cascade screening in BRCA1/2 positive families, using principles of the Health Action Process Approach model.
The manuscript is well-written and easily readable.
The methodology is robust, and the authors highlight the limits of a retrospective study.
Eligibility criteria are adequate.
Tables and figures are particularly clear.
Conclusions are consistent with the evidence and arguments presented.
References are adequate.
The manuscript is worthy of publication but I suggest:

- In the discussion section to acknowledge the effect of the cancer patient’s experience (side effects of chemo/hormonal therapy, physical deterioration, depression, anxiety, use of invasive procedures…etc) on the male relative’s adherence to cascade BRCA1/2 screening.

-It would be also interesting to acknowledge in the discussion the potential effect of the male participant being/having been a caregiver of the female relative, on the adherence to screening.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

I welcome the opportunity to review and offer comments on a paper that seeks to explore the nature of psychological factors in genetic cancer screening for males.

I find the term ‘brief longitudinal design' to be problematic especially since the time between time points is only 3 weeks, I would suggest rephrasing this expression.

Have the authors explored the impact in the perception of outcome of the test. For example one individual may find a positive test result to be beneficial in terms of knowing their heightened risk factor for disease, whereas others may identify this knowledge as being very detrimental at least in the short term.

Had you considered comparing the actual similarities of experience in those first-degree relatives. Simply being a first degree relative does not necessarily mean that one has a high level of contact and as such comparable levels of cancer experience with their relative.

I wonder if the predictive nature of intention for those with children relate to personal risk of death (the parent needing to be around to support their children) or more of a concern for passing genetic risk factors onto those offspring? Have you considered exploring the nature of this and how it may represent an individual difference?

Could the age findings be determined in the context of generational differences in cancer awareness? Younger individuals being more aware than older individuals in terms of prognosis and mortality.

I share the potential selection bias of the sample, however it is inherently problematic in a study of this nature – the findings derived from the data are nevertheless insightful to the area.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

A wonderful paper, well written, well designed and very coherent in all the parts, I would like to congratulate to the authors for the development of this article. Anyway, there are a few comments I would like to suggest:

• The initial part is very well descripted, with the concepts, the syndromes and the mutations. Maybe it would be useful to increase the level of explanation about the gender topic about the issue, and what kind of "specific concerns and idealized notions of masculinity” (line 47) are going to be analyzed.
• There is a global suggestion to write the paper in third-person, not in first person ("We...").
• There is no explanations about the aims of the study into the text, we can find one aim in the abstract and the aims in Discussion part. Please, include into the text a specific part about aims of the study to make easier the comprehension.
• Between lines 100 and 110, the authors describe the motivational topic and its influence in risk perception, and also the intention as a mediator. Then, in the methods, there are no direct indicators about these topics. It would be very interesting how the authors have managed both factors during the research (I suppose the assesment of Intention has been the indirect measure of motivation, but it´s not indicated into the text).
• Methods are amazing. I really appreciate the quality of the presentation of the methodology. Only the lack of my previous request about motivation and its connection with intention.
• Results are really interesting and very well presented. Only ine comment: in my opinion, it´s not necessary to explain "Furthermore, based on our hypothesis, a linear regression analysis was run to verify
  whether intention to undergo" (line 278), as all the readers understand the whole research has been done based on authors´ hypotheses.  
• Discussion is fully connected with the data and the Limitations part is also well descritped. Maybe it´s possible to include any bias in the limitations, such as the lack of control of any information the participants can searched by themselves. 
• About the references, I highly recommend to check more actual motivation references than Prochaska& Di clemente model, more adapted to XXIst century science (for sure, it´s valid but a new reference about motivation can be highly appreciated).  In general, I suggest to review the references

Author Response

Please see the attachment.

Author Response File: Author Response.pdf