Patient-reported outcome measures for advanced cancer in China: A systematic review of cross-cultural adaptation and psychometric properties

Background: The number of patients with advanced cancer in China is rapidly increasing. As services and policy evolve, it is essential to improve the quality of care by measuring outcomes of importance to patients and families by identifying patient-reported outcome measures (PROMs) for use with advanced cancer patients in China, and critically appraising their cross-cultural adaptation process and measurement properties. Methods: A systematic review was conducted in accordance with COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), with quality assessment using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and COSMIN quality criteria for measurement properties. MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI and WanFang were systematically searched from inception to May 2019, updated to August 2022. Supplemental searches were conducted in grey literature databases, Google scholar and hand-searching of reference lists.Results: From 10793 articles, 437 were selected for full-text review based on titles and abstracts. A total of 46 studies reporting 39 PROMs were retained. No articles were rated as good quality in more than four of the six stages of cross-cultural adaptation. At least half of the required information on psychometric properties was missing for each measure. Based on COSMIN, none identified PROMs were valid across all properties nor appropriate to use.Conclusion: There is currently no contextually appropriate and psychometrically sound PROMs for advanced cancer patients in China. The psychometric literature suggest that adaptation of existing measures is the potential solution. Policy summary: Developing outcome measures for advanced cancer patients in China is invaluable to improve audit, clinical services and assess the quality of care, for research purposes and secure funding. Future research in measures' development, refinement and cross-cultural adaptation in this field is urgently needed.

Automated summary

This study reviewed the issues related to advanced cancer patients in China and assessed the suitability and quality of existing outcome measures. The results showed that there are currently no appropriate and valid outcome measures for advanced cancer patients in China. Further research is needed to improve the care and assessment of patients in this population.