Table 6: Suggestions from key informants, focus group and cognitive interview participants, and study team members with resulting revisions and revision evaluation procedures.

Source Suggestion RevisionsEvaluation of revisions
Focus groups (RD 2)Cog IWsReading level scoringCSAT evaluatorsNot yet (future revision)

Key informant panelAssessment questionnaires should be rewritten because the reading level of some was too high.Implemented cognitive interviews to assess patient understanding.X
Educational text should be rewritten because the reading level was too high.Revised all educational information on SQI self-care and communication coaching to a lower reading level.XX
Pop-up definitions should define terms that may be unfamiliar.Added clickable pop-up in-context definitions.XX
Add detailed information on different treatment modalities.Added general information on what to expect during treatment, including the importance of communicating symptoms to the care team.X




Focus groups
Need assistance with Internet.Added screenshots illustrating use of ESRA-C.XX
Concerns about confidentiality with interpreters; unclear on role of some care team members.Revised and expanded description of clinical team to include interpreters and give more information on each role.
Explained that translators are professionals who have an obligation to keep private health information confidential.
XX
More information on specifics of what to expect during treatment wanted.Added links to information about treatment (surgery, chemotherapy, and/or radiation therapy) on the Dana-Farber website which can be customizable to institution.X

Focus groupsMore information on nutrition wanted.Link users to reputable web resources of appropriate reading level on nutrition for people undergoing cancer treatment.X
Add faces to pain numeric rating scale.Adapt version of faces scale to be consistent with the style of the existing interface.X

Cognitive interviewsSpecific terminology or question structures were difficult to understand.Revised translation of one questionnaire and noted other questionnaires for future revision or substitution.X

Research teamSimplify layout and interface.Revised layout and interface: larger, bolder fonts, fewer navigational links.XX
Add module on managing fatigue.Added information on exercise, including instructions and an activity diary, for fatigue management.XX

Reading level scoringOne section was scored at a 10th grade reading level and should be simplified.Revise this section and examine reading level of linked web resources.X

CSAT
reviewers
About 15 specific suggestions for wording changes or additional content were made.Review and consider implementation of these changes.X
Proxy patient shown was not representative of Hispanic patients.Consider adding photographs of more patients and families.X

Note: CSAT = cultural sensitivity assessment tool [40].