Challenges in a six-phase process of questionnaire adaptation: findings from the French translation of the Integrated Palliative care Outcome Scale

Abstract

Background The Integrated Palliative care Outcome Scale (IPOS) was developed for evaluating essential outcomes for palliative care patients. Our objectives here are to describe the process of a six-phase cross-cultural adaptation of IPOS to French (IPOS-Fr), highlight the difficulties encountered and strategies to solve them, and discuss the implications that adaptation may have on the validity and reliability of a questionnaire. Methods The adaptation of IPOS consisted of six phases: (i) literature review and interviews with target population; (ii) forward translation to French; (iii) backward translation to English; (iv) Expert Review; (v) cognitive interviews with target population; (vi) final review. Results Translation, cognitive interviews, and exchanges with Expert Review members allowed to make changes adapted to the target language regarding item 5 (“vomiting”) and 8 (“sore or dry mouth”), and to identify and address, in the original version of IPOS, syntactic inconsistencies in language used in items 11 to 15 and methodological problems with items 11 (“anxiety about treatment and illness”), 15 (“share … as much as you wanted”) and 17 (“problems addressed”). The adaptation also indicated that patients might have difficulties in interpreting items 8 (“sore or dry mouth”), 10 (“poor mobility”), 11 (“anxiety”), 12 (projected feelings of family and friends), and 14 (“feeling at peace”), thus indicating the need of monitoring during the psychometric validation. Conclusions Following this process, IPOS-Fr has proved content and face validity. In our case, the adaptation allowed adjustments to be made to the questionnaire and, when this was not possible, highlighted potential biases and inconsistencies during the validation. The result relied on an intertwined and iterative process of seeking and reaching semantic, conceptual, and normative equivalence. We are now assessing the psychometrical properties of IPOS-Fr.

Validation and cultural adaptation of the Integrated Palliative care Outcome Scale (IPOS) for the Portuguese population

“…Regarding the translation process and cultural adaptation there were, as expected, adjustments made to the direct translation of some concepts and in the overall appearance of the measure. These changes are well aligned with the literature, mainly with the French [ 18 ] and Swedish [ 19 ] translations and cultural adaptions of this measure. Regarding the open question items 1a, 1b and 1c, these gave insights to some of the issues worrying patients, which was important and informative for healthcare professionals to act upon in real time.…”

Challenges in the cultural adaptation of the German Myeloma Patient Outcome Scale (MyPOS): an outcome measure to support routine symptom assessment in myeloma care

“…Similar findings have been reported in cognitive interviews during the German translation of the IPOS [25] and its Italian translation [51]. The issue around culturally adapting Q9 as well as Q19, both referring to problems of a financial or personal nature being addressed, was also reported in the French and Italian translation of Q9 in the IPOS [51,52]. Additional problems concerning the response options have been described.…”

Translation and cultural adaptation of IPOS (integrated palliative care outcome scale) in Estonia

“…The staff does not require special training to use the questionnaire, and it can be filled in quickly by both patients and staff members [3,9]. The IPOS questionnaire has been widely used in studies and in clinical practice [3,9,[13][14][15][16]. The first question is openended and asked for the main problems or concerns of the patient over the past three or seven days (depending whether the questionnaire with recall time three or seven days is used).…”