Prior Study of Cross-Cultural Validation of McGill Quality-of-Life Questionnaire in Mainland Mandarin Chinese Patients With Cancer

Patient-reported outcome measures for advanced cancer in China: A systematic review of cross-cultural adaptation and psychometric properties

BACKGROUND

The number of patients with advanced cancer in China is rapidly increasing. As services and policy evolve, it is essential to improve the quality of care by measuring outcomes of importance to patients and families by identifying patient-reported outcome measures (PROMs) for use with advanced cancer patients in China, and critically appraising their cross-cultural adaptation process and measurement properties.

METHODS

A systematic review was conducted in accordance with COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), with quality assessment using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and COSMIN quality criteria for measurement properties. MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI and WanFang were systematically searched from inception to May 2019, updated to August 2022. Supplemental searches were conducted in grey literature databases, Google scholar and hand-searching of reference lists.

RESULTS

From 10793 articles, 437 were selected for full-text review based on titles and abstracts. A total of 46 studies reporting 39 PROMs were retained. No articles were rated as "good quality" in more than four of the six stages of cross-cultural adaptation. At least half of the required information on psychometric properties was missing for each measure. Based on COSMIN, none identified PROMs were valid across all properties nor appropriate to use.

CONCLUSION

There is currently no contextually appropriate and psychometrically sound PROMs for advanced cancer patients in China. The psychometric literature suggest that adaptation of existing measures is the potential solution.

POLICY SUMMARY

Developing outcome measures for advanced cancer patients in China is invaluable to improve audit, clinical services and assess the quality of care, for research purposes and secure funding. Future research in measures' development, refinement and cross-cultural adaptation in this field is urgently needed.

Revision and Validation of the Chinese Version of the McGill Quality of Life Questionnaire for ICU End-of-Life Patients

BACKGROUND

Hospice care for end-of-life patients in the ICU should focus on quality of life. Currently, there are no specific quality-of-life measures for ICU end-of-life patients in China.

OBJECTIVE

The aim of this study was to revise and culturally adapt the Taiwanese version of the McGill Quality of Life Questionnaire (MQOL-Taiwan) and to test its reliability and validity to provide an effective instrument for assessing the quality of life of ICU patients at the end of life.

METHODS

The revision and cultural adaptation of the MQOL-Taiwan were performed to develop a Chinese version of the McGill Quality of Life Questionnaire for ICU end-of-life patients (MQOL-ICU). A total of 156 ICU doctors, 286 ICU nurses and 120 ICU family members of end-of-life patients were surveyed with the revised scale to evaluate the quality of life of ICU patients at the end of life. The content validity, construct validity, and internal consistency of the scale were measured after the revision.

RESULTS

The Chinese version of the MQOL-ICU scale was formed based on the MQOL-Taiwan scale, which includes 8 items. For the Chinese version of the MQOL-ICU, the item-content validity index (I-CVI) ranged from 0.789 to 0.905, and the average scale-level content validity index (S-CVI/Ave) was 0.845. After exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) value was 0.700, and 3 dominant factors were extracted: physical and psychological symptoms, existential well-being, and support. In addition, 70.385% of the total variance was explained. The internal consistency (Cronbach's α) coefficient of the whole MQOL-ICU was 0.804, and the coefficients for the 3 domains ranged from 0.779 to 0.833.

CONCLUSION

The Chinese version of the MQOL-ICU showed good reliability and validity, and it can be used to assess the quality of life of ICU patients at the end of life.

Momentary pain assessments reveal benefits of endoscopic discectomy: a prospective cohort study

Both pain rating and exponential model revealed that percutaneous endoscopic lumbar discectomy provided rapid pain recovery that was maintained for at least 3 months compared with conservative treatments.

Lumbar disc herniation (LDH) is a common back disorder that evokes back and/or leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for patients with LDH. However, there is little evidence of effectiveness of PELD compared with conservative treatments.

Whole-brain functional network disruption in chronic pain with disk herniation

Brain functional network properties are globally disrupted in multiple musculoskeletal chronic pain conditions. Back pain with lumbar disk herniation (LDH) is highly prevalent and a major route for progression to chronic back pain. However, brain functional network properties remain unknown in such patients. Here, we examined resting-state functional magnetic resonance imaging-based functional connectivity networks in chronic back pain patients with clear evidence for LDH (LDH-chronic pain n = 146), in comparison to healthy controls (HCs, n = 165). The study was conducted in China, thus providing the opportunity to also examine the influence of culture on brain functional reorganization with chronic pain. The data were equally subdivided into discovery and validation subgroups (n = 68 LDH-chronic pain and n = 68 HC, for each subgroup), and contrasted to an off-site data set (n = 272, NITRC 1000). Graph disruption indices derived from 3 network topological measurements, degree, clustering coefficient, and efficiency, which respectively represent network hubness, segregation, and integration, were significantly decreased compared with HC, across all predefined link densities, in both discovery and validation groups. However, global mean clustering coefficient and betweenness centrality were decreased in the discovery group and showed trend in the validation group. The relationship between pain and graph disruption indices was limited to males with high education. These results deviate somewhat from recent similar analysis for other musculoskeletal chronic pain conditions, yet we cannot determine whether the differences are due to types of pain or also to cultural differences between patients studied in China and the United States.

Current Research Status of Palliative Care in Mainland China

Objectives:

This study aimed to obtain an overview of the current research status of palliative care in Mainland China and identify research directions for future studies by characterizing palliative care studies conducted among patients with any life-limiting illness in Mainland China and published in a peer-reviewed journal before November 2016.

Methods:

A review guide with 7 categories was initially developed based on existing international palliative care definitions and guidelines through content analysis. Ten databases were used to identify relevant studies from the inception of online cataloging to November 2016. Studies conducted in Mainland China and their research topic that fell within one of the categories of the review guide were included for further analysis. Descriptive analysis was adopted to summarize the relevant findings.

Results:

54 studies found to be relevant were included for the analysis. Three studies on “palliative care education and training” (category 1) asserted that education and training programs were scant in Mainland China and that only 1 program had been devised within the health-care context of Shanghai. Five studies on “palliative care screening and timely identification” (category 2) highlighted the absence of early screening criteria or checklists and referral procedures for palliative care. Thirty-one studies on “palliative care needs assessment (n = 12/31) and implementation (n = 19/31)” (category 3) were identified, and various methodological flaws were observed in most of these included studies. Twelve studies on “advanced decision-making” (category 4) were identified, all of which focused on investigating the attitudes of patients with cancer, their families, and/or health-care professionals toward advanced decision-making only. The percentage of patients, family members, and health-care professionals who held positive attitudes toward advanced decision-making were varied and suboptimal, particularly for family members (51.4%-58.0%). Five studies on “caring for patients at the end of life” (category 5) were identified, and the experience of health-care professionals in caring for those patients was explored. No studies relating to “death and bereavement care” (Category 6) and “psychological support for palliative care providers” (Category 7) were identified.

Conclusion:

The current research status of palliative care in Mainland China remains at an early stage with minimal palliative care services used. Although several knowledge gaps were identified, the first step, which should be addressed, is assessing the palliative care needs. An appropriate and ongoing needs assessment could provide important information for constructing comprehensive education and training programs of palliative care, identifying prognostic factors of timely palliative care referral, and developing evidence-based and tailored palliative care services.

The do-not-resuscitate order for terminal cancer patients in mainland China: A retrospective study

With the development of palliative care, a signed do-not-resuscitate (DNR) order has become increasingly popular worldwide. However, there is no legal guarantee of a signed DNR order for patients with cancer in mainland China. This study aimed to estimate the status of DNR order signing before patient death in the cancer center of a large tertiary affiliated teaching hospital in western China. Patient demographics and disease-related characteristics were also analyzed.This was a retrospective chart analysis. We screened all charts from a large-scale tertiary teaching hospital in China for patients who died of cancer from January 2010 to February 2015. Analysis included a total of 365 records. The details of DNR order forms, patient demographics, and disease-related characteristics were recorded.The DNR order signing rate was 80%. Only 2 patients signed the DNR order themselves, while the majority of DNR orders were signed by patients' surrogates. The median time for signing the DNR order was 1 day before the patients' death. Most DNR decisions were made within the last 3 days before death. The time at which DNR orders were signed was related to disease severity and the rate of disease progression.Our findings indicate that signing a DNR order for patients with terminal cancer has become common in mainland China in recent years. Decisions about a DNR order are usually made by patients' surrogates when patients are severely ill. Palliative care in mainland China still needs to be improved.

Development and validation of the quality care questionnaire -palliative care (QCQ-PC): patient-reported assessment of quality of palliative care

BACKGROUND

In this study, we aimed to develop and validate an instrument that could be used by patients with cancer to evaluate their quality of palliative care.

METHODS

Development of the questionnaire followed the four-phase process: item generation and reduction, construction, pilot testing, and field testing. Based on the literature, we constructed a list of items for the quality of palliative care from 104 quality care issues divided into 14 subscales. We constructed scales of 43 items that only the cancer patients were asked to answer. Using relevance and feasibility criteria and pilot testing, we developed a 44-item questionnaire. To assess the sensitivity and validity of the questionnaire, we recruited 220 patients over 18 years of age from three Korean hospitals.

RESULTS

Factor analysis of the data and fit statistics process resulted in the 4-factor, 32-item Quality Care Questionnaire-Palliative Care (QCQ-PC), which covers appropriate communication with health care professionals (ten items), discussing value of life and goals of care (nine items), support and counseling for needs of holistic care (seven items), and accessibility and sustainability of care (six items). All subscales and total scores showed a high internal consistency (Cronbach alpha range, 0.89 to 0.97). Multi-trait scaling analysis showed good convergent (0.568-0.995) and discriminant (0.472-0.869) validity. The correlation between the total and subscale scores of QCQ-PC and those of EORTC QLQ-C15-PAL, MQOL, SAT-SF, and DCS was obtained.

CONCLUSION

This study demonstrates that the QCQ-PC can be adopted to assess the quality of care in patients with cancer.

Translation and validation of Simplified Chinese version of the Pain Catastrophizing Scale in chronic pain patients: Education may matter

Objective

Pain catastrophizing is linked to many aspects of pain perception and defines a unique dimension in predicting pain intensity and physical disability. Pain Catastrophizing Scale (PCS) is an effective, validated,self-report measure, commonly used in clinical trials. Here, we present a Simplified Chinese PCS (SC-PCS) version developed in Chinese patients suffering from chronic pain.

Methods

The SC-PCS was generated in five steps and tested on an initial patient cohort (N = 30). A convenience sample (N = 200) of in-hospital patients with non-malignant pain lasting for more than 12 weeks were recruited for the study, of which 81 completed 5 additional pain questionnaires. A subset (N = 24) of the patients completed an additional SC-PCS, 10 days after the initial query to assess test–retest validation.

Results

Intra-class correlations coefficient indicated high reproducibility and temporal consistency, (0.97), for the total score. Cronbach’s alpha determined high internal consistency across the SC-PCS total score and its three subscales (0.87, 0.85, 0.62, and 0.65). The SC-PCS total score moderately or weakly (R = −0.2 to 0.49), but significantly, correlated with other measurements, such as pain Visual Analog Scale, Beck Depression Inventory, Pain Anxiety Symptoms Scales, Positive and Negative Affect Schedule, and education. We used exploratory factor analysis to examine the dimensionality of the SC-PCS, which indicated instability of the current three-factor model. However, a confirmatory factor analysis indicated that the three-factor model had the best goodness-fitting.

Conclusions

We demonstrate the successful translational adaptation from English to Simplified Chinese as well as the reliability and validity of SC-PCS. An important discovery was education level significantly correlated with SC-PCS, identifying a future consideration for other cross-cultural development of self-reported measures.

Psycho-oncology assessment in Chinese populations: a systematic review of quality of life and psychosocial measures

This systematic review describes psychosocial and quality of life (QOL) measures used in psycho-oncology research with cancer patients and caregivers in China. Medline and PsycINFO databases were searched (1980-2014). Studies reviewed met the following criteria: English language; peer-reviewed; sampled Chinese cancer patients/caregivers; developed, validated or assessed psychometric properties of psychosocial or QOL outcome measures; and reported validation data. The review examined characteristics of measures and participants, translation and cultural adaptation processes and psychometric properties of the measures. Ninety five studies met review criteria. Common characteristics of studies reviewed were they: assessed primarily QOL measures, sampled patients with breast, colorectal, or head and neck cancer, and validated existing measures (>80%) originating in North America or Europe. Few studies reported difficulties translating measures. Regarding psychometric properties of the measures >50% of studies reported subscale reliabilities <α = 0.70, <50% reported test-retest reliability, and <30% reported divergent validity. Few reported sensitivity, specificity or responsiveness. Improved accuracy and transparency of reporting for translation, cultural adaptation and psychometric testing of psychosocial measures is needed. Developing support structures for translating and validating psychosocial measures would enable this and ensure Chinese psycho-oncology clinical practice and research keeps pace with international focus on patient reported outcome measures and data management.