Evaluation of cross-cultural adaptation and measurement properties of breast cancer-specific quality-of-life questionnaires: a systematic review.
OBJECTIVE
To assess the procedures of translation, cross-cultural adaptation, and measurement properties of breast cancer-specific quality-of-life questionnaires.


METHODS
Searches were conducted in the databases MEDLINE, EMBASE, CINAHL, and SciELO using the keywords: "Questionnaires," "Quality of life," and "Breast cancer." The studies were analyzed in terms of methodological quality according to the guidelines for the procedure of cross-cultural adaptation and the quality criteria for measurement properties of questionnaires.


RESULTS
We found 24 eligible studies. Most of the articles assessed the translation and measurement properties of the instrument EORTC QLQ-BR23. Description about translation and cross-cultural adaptation was incomplete in 11 studies. Translation and back translation were the most tested phases, and synthesis of the translation was the most omitted phase in the articles. Information on assessing measurement properties was provided incompletely in 23 articles. Internal consistency was the most tested property in all of the eligible articles, but none of them provided information on agreement. Construct validity was adequately tested in only three studies that used the FACT-B and QLQ-BR23. Eight articles provided information on reliability; however, only four found positive classification. Responsiveness was tested in four articles, and ceiling and floor effects were tested in only three articles. None of the instruments showed fully adequate quality.


CONCLUSIONS
There is limited evidence on cross-cultural adaptations and measurement properties; therefore, it is recommended that caution be exercised when using breast cancer-specific quality-of-life questionnaires that have been translated, adapted, and tested.
Universidade Cidade de São Paulo, Rua Cesário Galeno 448/475, Tatuapé, São Paulo, SP, CEP 03071-000, Brazil.
Indiara Soares
IS
Oliveira
Lucíola
L
da Cunha Menezes Costa
Felipe Ribeiro Cabral
FR
Fagundes
Cristina Maria Nunes
CM
Cabral
D001943:Breast Neoplasms / Q000523:psychology*; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D018864:Cultural Diversity; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D007802:Language; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014175:Translating; D014177:Translations