Cross-cultural influences affect perceptions and health practices, which are 2 areas of nursing concern. Culturally sensitive assessment instruments are needed, but many challenges exist in obtaining valid and reliable measurement. Translating questionnaires for cross-cultural research is fraught with methodological pitfalls related to colloquial phrases, jargon, idiomatic expressions, word clarity, and word meanings. It cannot be assumed that a particular concept has the same relevance across cultures. Simply translating an English version word-for-word into another language is not adequate to account for linguistic and cultural differences. Ideally, the perspectives of people from the culture about the concept of interest should be studied first, but often a practical alternative is to find and translate a tool developed in another culture. The purpose of this article is to describe important considerations in conducting translation for equivalence, types of equivalence, and strategies to translate instruments that promote equivalence and how to test the translated version for equivalence. These concepts and strategies are illustrated by describing the translation process of Hilton's Uncertainty Stress Scale into French and the use and testing of the French version with a French Canadian sample in Skrutkowski's study of perceived uncertainty in adult survivors of cancer.

Experienced nurses with specialized knowledge of oncology symptom assessment and management may reduce the symptom burden experienced by ambulatory patients with breast or lung cancer during active treatment.

BackgroundManagement of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments.MethodsA prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings.DiscussionGiven the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.