The authors put women in the centre stage and infer the discomfort experience from a set of qualitative variables: before, during and after the mammography session. The study was conducted to give a holistic idea of the experience as perceived by women, hence the contrast to earlier studies. In most of the early studies, the discomfort was assessed during the mammography by looking at variables such as anxiety, beliefs, coping strategies and so forth; the samples were large and the mammogram is at the centre stage. In other studies, the investigators went to include seemingly less related factors to the experience such as the perception of the centre and privacy. These studies, unlike their first counterparts, do not address the "during" experience. In their report the authors aim to combine the two approaches and examine the experience: before the screening (just the thought of it), through screening (the day experience), and after screening.
The authors have looked at the literature and describe it, but allowed evaluating the theoretical background of some studies such as the model used to establish the discomfort experience. In some studies, for example the number of patients and the questionnaires were both evaluated. Having said that, not all up to date literature was discussed. Sapir et al, for instance, has done a review of the mammography discomfort literature from 1988 to 2001 with quantitative results that would have been beneficial to the qualitative approach design. The study was conducted so that patients express their experience in their own words; this has the benefit of getting the exact effects of the experience, but has the difficulty of categorising and interpreting the data collected from the participants. This study approach however, is one of the first to get patients to express themselves, hence reflecting high qualitative value as the authors rightly suggested.
To achieve this, the authors first recruited women from a breast screening centre, and using the theoretical framework explained above for the study design, chose their participants. Twelve women were selected based on characteristics that will infer a qualitative dimension to the study such as age, risk and discomfort perception, frequency of screening, and other factors contributing to the experience including social and cultural factors. The selective procedure was aimed at gathering information from patients till no more is needed and infer conclusions, in short theoretical saturation. The women chosen, can be argued, are less representative of the entire screening population at hand due to the selection procedure. For example, only around 70% of women in earlier studies have reported discomfort, and only few can be aligned with the criteria set by the investigators. It may be plausible to use other categories: those who do not subscribe to the selection procedure or those who show no discomfort, and be used as control samples for this study. The other two groups will have similar qualitative parameters to respond to before the experience as those selected for the study, but may have different personal outcomes, hence the authors would pinpoint the qualities needed for further improvement or research. These restrictions, somehow biased, are not well characterised or explicitly and quantitatively expressed,