title: Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses.
abstract: The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is one of the most widely used quality of life instruments for cancer patients. The aim of this study was to assess whether there were linguistic differences in the way an international sample answered the EORTC QLQ-C30 questionnaire. Thirteen translations of the EORTC QLQ-C30, representing 22 countries, were investigated using a database of 27,891 respondents, incorporating 103 separate studies. Differential item functioning (DIF) analyses were conducted using logistic regression to identify items which, after controlling for subscale, were answered differently by language of administration. Both uniform and non-uniform DIF were assessed. Although most languages showed similar results to English, at least one instance of statistically significant DIF was identified for each translation, and a few of these differences were large. In some cases, the patterns were supported by the results of qualitative interviews with bilingual people. Although, overall, there appeared to be good linguistic equivalence for most of the EORTC QLQ-C30 items, several scales showed strongly discrepant results for some translations. Some of these effects are large enough to impact on the results of clinical trials. Based on our experience in this study, we suggest that validation of translations of health-related quality of life instruments should include exploration of DIF.
authors.affiliation: Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK, and Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: N W
authors.initials: NW
authors.lastname: Scott
authors.forename: P M
authors.initials: PM
authors.lastname: Fayers
authors.forename: A
authors.initials: A
authors.lastname: Bottomley
authors.forename: N K
authors.initials: NK
authors.lastname: Aaronson
authors.forename: A
authors.initials: A
authors.lastname: de Graeff
authors.forename: M
authors.initials: M
authors.lastname: Groenvold
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.forename: M A
authors.initials: MA
authors.lastname: Petersen
authors.forename: M A G
authors.initials: MA
authors.lastname: Sprangers
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D019992:Databases as Topic; D005060:Europe; D005260:Female; D006801:Humans; D038622:Internationality; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology*; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014177:Translations