Impact of Cultural and Linguistic Factors on Symptom Reporting by Patients With Cancer
Impact of Cultural and Linguistic Factors on Symptom Reporting by Patients With Cancer
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DOI：
10.1093/jnci/djq097
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发表时间：
2010-05-19
影响因子：
10.3
通讯作者：
Johnson, Valen E.
中科院分区：
文献类型：
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作者：
Wang, Xin Shelley;Cleeland, Charles S.;Johnson, Valen E.
患者报告症状的严重程度和影响是癌症症状管理和癌症治疗临床试验的重要组成部分。在多国临床试验中，患者报告结果工具中的文化和语言差异可能会混淆研究结果的解释。方法采用经心理测量学验证的md安德森症状量表（MDASI），对来自美国、中国、日本、俄罗斯和韩国的1433例混合诊断和治疗状态的癌症患者的多重症状的严重程度和干扰程度进行测量。将混合效应有序概率回归模型拟合到汇总数据中，比较“国家”（民族和语言因素）对症状报告的影响程度与受试者之间的影响程度，并根据患者和临床因素（年龄、性别、表现状况和化疗状况）进行调整。结果在合并的样本中，疲劳、睡眠紊乱、焦虑、疼痛和食欲不振是患者报告的最严重的MDASI症状。除恶心和呕吐外，国家随机效应的变异幅度仅为患者间变异的1 / 4到1 / 2 （sigma(2) = 0.23-0.46）。结论：经验证的MDASI的五种语言版本在症状报告中的文化和语言差异是有限的。顺序概率模型提供了一种简单的机制来解释患者群体中的文化和语言差异。本研究中MDASI翻译之间的等价性表明，使用MDASI从不同文化和语言群体收集的症状评分可以在肿瘤学实践、临床试验和临床研究中以类似的方式解释。
Background Patient reporting of the severity and impact of symptoms is an essential component of cancer symptom management and cancer treatment clinical trials. In multinational clinical trials, cultural and linguistic variations in patient-reported outcomes instruments could confound the interpretation of study results.Methods The severity and interference of multiple symptoms in 1433 cancer patients with mixed diagnoses and treatment status from the United States, China, Japan, Russia, and Korea were measured with psychometrically validated language versions of the M. D. Anderson Symptom Inventory (MDASI). Mixed-effect ordinal probit regression models were fitted to the pooled data to compare the magnitude of the effect of "country" (nation and linguistic factors) with between-subjects effects on symptom reporting, adjusted for patient and clinical factors (age, sex, performance status, and chemotherapy status).Results For the pooled sample, fatigue, disturbed sleep, distress, pain, and lack of appetite were the most severe patient-reported MDASI symptoms. The magnitude of the variance of the country random effects was only one-fourth to one-half of the interpatient variation (sigma(2) = 0.23-0.46) for all symptoms, except nausea and vomiting.Conclusions Cultural and linguistic variations in symptom reporting among the five language versions of the validated MDASI were limited. Ordinal probit modeling provided a simple mechanism for accounting for cultural and linguistic differences in patient populations. The equivalence among MDASI translations in this study suggests that symptom ratings collected from various cultural and language groups using the MDASI can be interpreted in a similar way in oncology practice, clinical trials, and clinical research.