The Singaporean English and Chinese versions of the EQ-5D achieved measurement equivalence in cancer patients.

OBJECTIVE: To assess measurement equivalence of the Singaporean English and Chinese versions of the EuroQol Group's 5-domain questionnaire (EQ-5D) in cancer patients. STUDY DESIGN AND SETTING: Seven hundred and seventy-one ethnic Chinese patients in Singapore were recruited, and they answered either an English or a Chinese version of the EQ-5D. Seven days later, a similar questionnaire in the same language was mailed to the patients. Regression analysis was used to assess equivalence of the mean values obtained by using the two language versions. The validity, responsiveness to change, and reliability of the two versions of the EQ-5D were assessed and compared. RESULTS: Based on the prespecified equivalence margin of +/-10% for binary outcome, +/-0.05 for utility index, and +/-5 points in the visual analog scale, the two language versions of the EQ-5D gave equivalent mean values at item and scale levels. They also showed similar characteristics in validity, responsiveness, and reliability. For example, the test-retest reliability values for the EQ-5D utility index in the two language samples were identical in two significant digits: 0.79. CONCLUSION: The Singaporean English and Chinese versions of the EQ-5D were validated in cancer patients and were shown to achieve measurement equivalence.

Mapping the English and Chinese versions of the Functional Assessment of Cancer Therapy-General to the EQ-5D utility index.

OBJECTIVE: This study aims to develop a function for mapping the English and Chinese versions of the Functional Assessment of Cancer Therapy-General (FACT-G) scores to the EuroQoL Group's EQ-5D utility index and to test whether a single function is sufficient for the two language versions. METHODS: A baseline survey of 558 cancer patients in Singapore using the FACT-G and EQ-5D was conducted (308 English and 250 Chinese questionnaires). Regression models were used to predict the EQ-5D utility index values based on the FACT-G scores and thus derive a mapping equation. Data from a follow-up survey of the patients were used to validate the results. RESULTS: The FACT-G Social/Family scale was not associated with the EQ-5D utility index (P = 0.701). There was no interaction between language version and the predictors (each P > 0.1). An equation that maps the FACT-G Physical, Emotional, and Functional well-being scales to the EQ-5D utility index was derived. In the validation sample, the mean observed utility values was larger than the mapped by only 0.005 (95% confidence interval [CI]-0.006 to 0.016), but the mean absolute difference was 0.083 (95% CI 0.076 to 0.090). CONCLUSIONS: At the group level, but not individual level, the equation developed can accurately map the English and Chinese versions of the FACT-G scores to the EQ-5D utility index.

Response and non-response to a quality-of-life question on sexual life: a case study of the simple mean imputation method.

We investigated the non-response rates to the question "I am satisfied with my sex life" in the Functional Assessment of Cancer Therapy-General questionnaire in Chinese (n = 769), Malay (n = 41) and Indian (n = 33) patients in Singapore, a multi-ethnic society whose residents are said to have a conservative sexual attitude. Non-response rates to the question were 44%, 22% and 24% in the three groups respectively. The rates were much higher than that reported previously in a US study (7%) and used in the associated simulation study of the simple mean imputation method. We further examined the Chinese respondents in detail. The odds of non-response and the scores among the responders were associated with several demographic and clinical characteristics. Using the checklist proposed by Fayers et al. [Stat Med 1998; 17: 679-696] to assess the data patterns, we found that the application of the simple mean imputation is questionable. We employed an alternative (multiple) imputation procedure that took into account covariates that predicted the odds of non-response and the observed response scores. We compared the analytic results based on different approaches to handling missing values, and found that analysis based on the simple mean imputation gave results similar to that based on multiply imputed data even in this quite extreme example.

Cancer patients' preferences for communication of unfavourable news: an Asian perspective.

It is important to understand cancer patients' preferences for communication as it impacts on how unfavourable news should be delivered in such a way as not to demoralize the patients while at the same time maintain good doctor-patient relationships. However, few studies have been undertaken in the Asian countries. This study aims to determine the preferences of cancer patients regarding the disclosure of unfavourable news in an Asian population in Singapore. Two hundred cancer patients at the National Cancer Centre, Singapore, completed a Measure of Patients' Preferences (MPP) questionnaire on how they would like their physicians to tell them unfavourable news about their condition. The patients rated the content and context of the communication as well as the physicians' characteristics on a five-point Likert scale. Items that scored the highest mostly related to physicians' expertise and content of the interaction, while those relating to the supportive aspects scored the lowest. Gender was significantly associated with scores on the support subscale of the MPP such that women reported that the supportive elements were more important than the men did. No other demographic and medical characteristics were associated with patients' preferences. Exploratory factor analysis yielded two main factors, which accounted for 79.38% of the common variance. Patients' preferences in our local Asian population are fairly similar to those obtained from other studies conducted in the West, despite possible socio-cultural differences such as the use of euphemisms.

Quick-FLIC--a short questionnaire for assessing quality of life of cancer patients.

Health-related quality of life instruments tend to include a great many items. This imposes a burden on the respondents as well as undermining response rate and data quality. In this study we developed a shortened version of the Functional Living Index-Cancer (FLIC), now called Quick-FLIC, and examined its measurement properties. A questionnaire package, self-administered by 140 patients, included the FLIC and the Functional Assessment of Cancer Therapy-General. A factor analysis and clinical judgement were used to shorten the FLIC, which included 22 items. Each subscale of FLIC was shortened to include two or three items only. The Quick-FLIC included a total of only 11 items. Nevertheless, the measurement properties of the Quick-FLIC and its subscales were comparable to those of the original FLIC. It is concluded that the shortening of established health-related quality of life instruments is viable in oncology research.