Evaluating the Linguistic Appropriateness and Cultural Sensitivity of a Self-Report System for Spanish-Speaking Patients with Cancer

Table 4

Cognitive interview results: instruments, items, number participants per instrument, and issues.

Instrument	Items	Number of participants	Issues Identified
European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 (EORTC-C30) [30] Spanish US Version 3	30	21	Difficulty responding to items pertaining to time or distance.; Patients had concerns with shortness of breath item, relating it to asthma.; Difficulty with responding to pain questions, associating the question with different kinds of pain.; Difficulty with understanding the question of physical condition or medical treatment interfering with family life.
1-item neuropathy screener developed by research team	1	3	None reported or observed.
European Organization for Research and Treatment of Cancer Chemotherapy-Induced Peripheral Neuropathy 20; (CIPN20) [31]	20	19	Did not understand meaning of “adormecidos” (numbness) or “boligrafo” (pen).
Patient Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form 6a [32, 33]; Spanish v1.0	6	12	Did not understand meaning of “ocio” (leisure).
PROMIS Fatigue 7a Spanish v1.0 [34]	7	18	Did not understand meaning of “extenuación” (exhaustion).
PROMIS Depression 8a Spanish v1.0 [35]	8	12	None reported or observed.
Expanded Prostate Cancer Index Composite for Clinical Practice [36] (EPIC-CP)	16	6	Did not understand meaning of “almohadilla” (supposed to mean pad).; The word “pad” does not have to be repeated in the response options since it was already in the question.; Did not understand that men with prostate cancer could have these symptoms.; Thought that “flujo” meant infection, not flow.; Confused about the difference in response options (very small, small, moderate, or big problem).; Confused about whether “funcion sexual” included both functional aspect and sexual desire.
EPIC-CP (revised translation)	16	9	Preferred the word “pañales” (diapers) rather than “protectores” (protectors).; Did not understand meaning of “defecar” (bowel movement); preferred the word “evacuar.”; Spanish slang terms for reaching orgasm (“venirse” or “acabar”), included in parentheses to assist low literacy readers, were offensive.; Found the new word for flow (“chorrito”) appropriate.
Symptom Distress Scale [37] (SDS) Southwest Oncology Group Spanish version	13	14	Difficulty with similarity of the answer sets.; Difficulty formulating response for insomnia (some with aches and pains keeping them up; they took a sleep aid to fall asleep).; Not possible to be worried and not afraid.
Patient Health Questionnaire-Nine Symptom Checklist [38, 39] (PHQ-9) Spanish for USA	9	18	Difficulty understanding question and answers.; Difficulty understanding either/or questions (e.g., trouble falling or staying asleep or sleeping too much); thought they should be asked individually.
Religion/Spirituality Questionnaire	4	12	None reported or observed.
Skin Problems Questionnaire	1	5	None reported or observed.