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Shunmugasundaram C, Sundaresan P, White K, King MT, Milross C, Rodd L, Fuller M, Rutherford C. Development and implementation barriers of a new patient-reported measure: The Radiation therapy-related Inconvenience Questionnaire (RIQ). J Med Imaging Radiat Oncol 2023; 67:777-788. [PMID: 37742323 DOI: 10.1111/1754-9485.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Radiation therapy (RT) can benefit approximately 50% of cancer patients and contribute to 40% of all cancer cures, yet its utilisation in cancer is low globally. Several factors contribute to this including perceived inconvenience related to accessing and utilising RT. To quantitatively assess the latter, a new tool - the Radiation therapy-related Inconvenience Questionnaire (RIQ) - was developed. This study aimed to pre-test the RIQ and explore barriers and facilitators to implementing it in routine clinical practice and clinical trials. METHODS Semi-structured cognitive interviews were conducted with patients undertaking RT, recruited via three hospitals to examine content validity, acceptability, and comprehensibility of the RIQ. Interviews identified inconsistencies, relevance, and clarity of items. Semi-structured interviews with healthcare professionals involved in the delivery of care to individuals undertaking RT explored barriers and facilitators to routine usage. Thematic analysis was used to identify themes. RESULTS Patients (N = 15) identified problems in content, instructions, layout, length, and response options; consequently, 25 items were revised and eight removed, resulting in a final 29-item questionnaire. Clinicians identified staff- and patient-specific barriers to implementing RIQ in clinical practice. Perceived facilitators included the following: (a) workplace factors, (b) mode of administration, and (c) imparting knowledge. CONCLUSION This study demonstrated acceptability and comprehensibility of the 29-item RIQ amongst cancer patients undertaking RT and treating clinicians. The next phase will evaluate the RIQ's measurement properties in a larger clinical study. The barriers and facilitators identified can guide future implementation of RIQ in clinical practice and clinical trials.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, New South Wales, Sydney, Australia
- Sydney Medical School, The University of Sydney, New South Wales, Sydney, Australia
| | - Kate White
- Cancer Nursing Research Unit, The University of Sydney, Susan Wakil School of Nursing and Midwifery, New South Wales, Sydney, Australia
| | - Madeleine T King
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
| | - Chris Milross
- Sydney Medical School, The University of Sydney, New South Wales, Sydney, Australia
- Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, New South Wales, Sydney, Australia
| | - Lucinda Rodd
- Radiation Oncology, Central West Cancer Centre, New South Wales, Orange, Australia
| | - Matthew Fuller
- Radiation Oncology, Central West Cancer Centre, New South Wales, Orange, Australia
| | - Claudia Rutherford
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
- Cancer Nursing Research Unit, The University of Sydney, Susan Wakil School of Nursing and Midwifery, New South Wales, Sydney, Australia
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Bhardwaj T, Arora N, Paul A, Chowdhary P. Cultural Adaptation of Patient Health Questionnaire-9 in Hindi for Use with Patients with Cancer in Community Palliative Care Settings. Indian J Palliat Care 2023; 29:292-311. [PMID: 37700900 PMCID: PMC10493686 DOI: 10.25259/ijpc_96_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Patient Health Questionnaire-9 (PHQ-9) in Indian settings is yet not very often used in palliative care with the Hindi-speaking population. The Hindi version of PHQ-9 is available but its cultural adaptation to the Hindi-speaking population in North India receiving palliative care services is required to be tested. PHQ-9 as a depression screening questionnaire may help to identify depression symptoms among patients with cancer. This study aimed to examine the cultural equivalence of PHQ-9 Hindi for use with patients with cancer receiving palliative care services in North India. Material and Methods Based on the standard methodology of translation and adaptation of the scale, the following process was used: (i) Two focused group discussions with 17 experts working in a cancer palliative care setting, (ii) qualitative interviewing with 11 patients, and (iii) research team review. All interviews were audio recorded, transcribed, and item-wise content analysis was conducted. Results A few difficult phrases in the original PHQ-9 were 'dilchaspi', 'avasadgrast', 'kam urja', 'nakaam', parivar ko neecha dhikhana and 'ashthir' which were changed to Kam Mann Lagna, Mann Dukhi hona, kamjori, saksham nahi hain' 'asafal', Parivar ko nirash karna' and 'bechain,' respectively. Two items, namely no. 6 and 8 were changed to shorten the length for appropriately conveying the meaning. Conclusion Hindi language involves various dialects which change from region to region bringing variations in understanding the meaning of the words. It is recommended that culturally equivalent scales are used in practice and research. PHQ-9 is now culturally adapted for the Hindi-speaking population in North India. PHQ-9 will help identidy depressive symptoms at an early stage. Psychometric testing of PHQ-9 is underway.
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Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Neha Arora
- Department of Psychology, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Anu Paul
- Home Care, CanSupport, New Delhi, India
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Kanatas A, Lowe D, Rogers SN. The Patient Concerns Inventory in head and neck oncology: a structured review of its development, validation and clinical implications. Eur Arch Otorhinolaryngol 2022; 279:5097-5111. [PMID: 35842858 PMCID: PMC9519723 DOI: 10.1007/s00405-022-07499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
Introduction The Patient Concerns Inventory (PCI) is a condition specific prompt list that was initially developed for head and neck cancer (HNC) and is referred to as the PCI–HN. There have been numerous publications regarding the PCI–HN, since it was first published in 2009. To date, there has not been a review of its development, validation and clinical implications. A collation of relevant papers into key sections allows multidisciplinary teams and researchers to have an overview of the PCI–HN’s background, evaluation and utility. This is essential if colleagues are to have confidence in the tool and be able to reflect on how to optimise its use in clinical practice. Methods Five search engines were used: EMBASE, Medline, PubMed, CINAHL and Handle-on-QOL for the specific term ‘Patient Concerns Inventory’ up to and including 1st February 2022. In addition, an accumulation of PCI–HN data of 507 HNC patients was drawn from previous studies in Liverpool and Leeds between 2007 and 2020 and was analysed specifically for this paper. Results 54 papers relating to the PCI–HN were identified. The review is structured into eight sections: (1) What is the PCI–HN and how does it work; (2) Feasibility and acceptability; (3) Psychometrics; (4) Items selected and frequency (5) Associations with Health-Related Quality of Life (HRQOL) and casemix; (6) Other observational studies; (7) Randomised trial evaluation; (8) General discussion and further research. Conclusions As the term PCI is quite ubiquitous and produces many hits when searching the literature, this review provides a very concise and convenient historical context for the PCI–HN and collates the current literature.
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Affiliation(s)
- Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | | | - Simon N. Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, L39 4QP UK
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
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Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Huilgol N, Rutherford C. Body Image Scale: Evaluation of the Psychometric Properties in Three Indian Head and Neck Cancer Language Groups. Front Psychol 2022; 13:779850. [PMID: 35645858 PMCID: PMC9135105 DOI: 10.3389/fpsyg.2022.779850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Body image is a subjective concept encompassing a person's views and emotions about their body. Head and neck cancer (HNC) diagnosis and treatment affects several psychosocial concepts including body image. Large numbers of HNC patients are diagnosed each year in India but there are no suitable measures in regional languages to assess their body image. This study assessed the psychometric properties of the Body Image Scale (BIS), a measure suitable for clinical and research use in HNC populations, translated into Tamil, Telugu and Hindi and compared body image distress between language groups. Methods Translated versions of BIS were completed by HNC patients recruited from three cancer centers across India one time only. Psychometric evaluation was conducted including factor analysis using principal component analysis and internal consistency reliability using Cronbach's alpha. Patients completed the EORTC Quality of Life Questionnaire (QLQ) C-30 and EORTC QLQ HN-35 measures to enable exploration of convergent and discriminant validity. ANOVA was used to calculate difference in mean values for body image. Results Our sample included 621 HNC patients (Tamil = 205, Telugu = 216, Hindi = 200). Factor analysis revealed a one-factor solution and Cronbach's alpha coefficients ranged between 0.891 and 0.969 indicating good reliability. Hypothesized correlations between similar and different constructs were as expected, supporting construct validity. On the BIS, we found a statistically significant difference (F = 11.0954, P < 0.05) between means of Tamil, Telugu, and Hindi groups, with higher body image scores in Telugu (M = 12.86; SD = 7.65) and Hindi groups (M = 12.52; SD = 7.36) indicating more symptoms/body image distress, when compared to Tamil population (M = 9.28; SD = 10.04). Conclusion The reliability and validity of the three translated Indian versions of the BIS were maintained, providing a method for assessing body image of HNC population worldwide speaking Tamil, Telugu, and Hindi across the illness trajectory.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis N. Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, India
| | - Niveditha Akula
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, India
| | | | - Nagraj Huilgol
- Division of Radiation Oncology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, The University of Sydney, Sydney, NSW, Australia
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Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Rutherford C. Patient-reported anxiety and depression measures for use in Indian head and neck cancer populations: a psychometric evaluation. J Patient Rep Outcomes 2021; 5:44. [PMID: 34097161 PMCID: PMC8184912 DOI: 10.1186/s41687-021-00316-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/06/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Head and neck cancers (HNC) are one of the most traumatic forms of cancer because they affect essential aspects of life such as speech, swallowing, eating and disfigurement. HNCs are common in India, with over 100,000 cases being registered each year. HNC and treatment are both associated with considerable anxiety and depression. With increasing multinational research, no suitable measures in Indian languages are available to assess anxiety and depression in Indian HNC patients. This study evaluated the psychometric properties of cross-culturally adapted versions of Zung's self-rating Anxiety Scale (SAS) and the Patient health questionnaire - 9 (PHQ-9) in Tamil, Telugu and Hindi speaking Indian HNC populations. METHODS HNC patients were recruited from three tertiary cancer centres in India. Patients completed the cross-culturally adapted versions of SAS and PHQ-9. We assessed targeting, scaling assumptions, construct validity (exploratory and confirmatory factor analyses), convergent validity, and internal consistency reliability. RESULTS The study sample included 205 Tamil, 216 Telugu and 200 Hindi speaking HNC patients. Exploratory and confirmatory factor analyses indicated a two-factor solution for PHQ-9 and four-factor solution for SAS in all three languages. Cronbach's alpha coefficients ranged between 0.717 and 0.890 for PHQ-9 and between 0.803 and 0.868 for SAS, indicating good reliability. Correlations between hypothesized scales were as expected providing evidence towards convergent validity. CONCLUSIONS This first psychometric evaluation of the measurement properties of Tamil, Telugu and Hindi versions of the SAS and PHQ-9 in large, Indian HNC populations supported their use as severity and outcome measures across the disease and treatment continuum.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia.
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia.
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Health & Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, India
| | - Niveditha Akula
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, India
| | | | - Claudia Rutherford
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
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