The proposed project has three specific aims directed toward language, culture, and literacy fair quality of life (QOL) evaluation of people with cancer: 1) To complete the adaptation of the Functional Assessment of Cancer Therapy (FACT) Scales for use with Spanish-speaking cancer patients; 2) To test the psychometric properties and statistical equivalence of the FACT scales across the following four variables: Language (Spanish versus English); Culture (Hispanic versus Black non- Hispanic versus White on-Hispanic); Literacy (Low versus High); and Mode of administration (Self versus Interview); and 3) To pilot language-, culture-, and literacy-fair assessment of QOL within the Eastern Cooperative Oncology Group (ECOG), including the possibility of collaboration with other NCI/NCNR-sponsored projects. In a six-month pilot study, semantic, content, and partial technical equivalence, already demonstrated in previous work with multiple expert bilingual/ bicultural advisors, will be confirmed with a second back-translation, patient interviews, and further expert advisory input. To this end, the Spanish language version of the general FACT scale plus five cancer- specific modules will be completed and evaluated during interviews with 90 Spanish-speaking patients. Then, after collecting one-time administration data from an estimated 1650 patients, and two-time assessment in a subsample of 200 Spanish-speaking patients, QOL data as recorded on the FACT will be subjected to a two-step testing for equivalence. The measurement step will test whether (as expected), FACT items are calibrated similarly across different levels of each of the four independent variables. The analysis step will test whether, after explaining differences in FACT scores attributable to performance status, socioeconomic status, gender and age, there remains any difference attributable to any of the four independent variables. To enable comparisons across literacy and mode of administration, high literacy patients will be randomly assigned to self versus interview administration, allowing for a test of technical equivalence. Two subsequent tests of equivalence between data generated by interview with high literacy patients versus data generated by interview with low- literacy patients, and between data generated by interview with low- literacy patients versus self-report, are (of necessity) not based upon random assignment. Piloting group wide in ECOG will emphasize protocol development, standardization of administration method group wide, training of support staff, and implementation of quality control procedures. Four Eastern Cooperative Oncology Group (ECOG) institutions will participate in the first 2.5 years of the project: Grady Memorial Minority Community Clinical Oncology Program (CCOP; Atlanta), San Juan Minority CCOP (Puerto Rico), St. Vincent's Hospital (New York City), and Rush-Presbyterian/Cook County Hospital (Chicago). The last six months of this three-year proposal will include implementation strategies across all ECOG institutions that participate in five selected ECOG trials (one trial for each cancer studied: breast, colon, head and neck, HIV-related, and lung).
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