Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2023 May 1;116(1):166-175. doi: 10.1016/j.ijrobp.2023.01.031. Epub 2023 Jan 28.
Cancer is the leading cause of death for the Hispanic/Latinx United States (US) community, which comprises 64% of the US population with limited English proficiency. Despite the common use of radiation therapy for cancer treatment, there is a dearth of radiation therapy educational materials-at appropriate reading levels-available in Spanish. To address the gap in patient-centered educational resources for communicating with Spanish-speaking patients about radiation therapy, we sought to linguistically and culturally adapt the Communicating the External Beam Radiotherapy Experience (CEBRE) clinical discussion guide series into Spanish.
From January to December 2021, we developed and applied a stepwise methodology for Spanish adaptation of the discussion guides involving (1) professional translation; (2) interprofessional review for linguistic and cultural appropriateness and medical accuracy; (3) design review; and (4) evaluation for readability, understandability, and actionability using validated tools. We applied 4 indices for readability evaluation: Gilliam-Peña-Mountain, Läsbarhetsindex, Rate Index, and the Spanish Simple Measure of Gobbledygook. Two trained reviewers assessed understandability and actionability using the Patient Education Materials Assessment Tool.
After 2 revision rounds, 4 CEBRE en español discussion guides were produced through an interprofessional, iterative translation and linguistic/cultural adaptation process. Readability scores across the 4 guides ranged from 4.3 to 7.3 grade-level equivalents, thereby meeting the American Medical Association's 8th-grade standard. Patient Education Materials Assessment Tool analysis yielded near-perfect scores along understandability and actionability domains.
The stepwise linguistic/cultural adaptation process yielded a patient-centered guide that is appropriately readable, understandable, and actionable for Spanish-speaking patients receiving radiation therapy in the US. Future work should include an external evaluation of CEBRE en español by clinicians and patients. The methodology described can be applied to adapting resources for patient-centered communication in other fields of medicine and into other languages as part of an interprofessional approach to delivering equitable health care for all.
癌症是美国西班牙裔/拉丁裔社区（美国）的主要死亡原因，该社区占美国人口的 64%，英语水平有限。尽管放射治疗在癌症治疗中被广泛应用，但西班牙语的放射治疗教育材料却严重匮乏，且阅读水平适宜。为了弥补与西班牙语患者沟通时以患者为中心的教育资源的不足，我们试图将《放射治疗体验交流临床讨论指南》（CEBRE）系列进行语言和文化上的改编，使其成为西班牙语版本。
从 2021 年 1 月至 12 月，我们开发并应用了一种逐步的方法，对讨论指南进行西班牙语改编，包括（1）专业翻译；（2）专业人员对语言和文化适宜性以及医学准确性进行审查；（3）设计审查；（4）使用经过验证的工具评估可读性、可理解性和可操作性。我们应用了 4 个可读性评估指标：Gilliam-Peña-Mountain、Läsbarhetsindex、Rate Index 和西班牙简单混淆度测量。两名经过培训的评审员使用患者教育材料评估工具评估了可理解性和可操作性。
经过两轮修订，通过跨专业、迭代式的翻译和语言/文化改编过程，产生了 4 个 CEBRE en español 讨论指南。4 个指南的可读性评分在 4.3 到 7.3 年级水平等价物之间，满足美国医学协会的 8 年级标准。患者教育材料评估工具分析在可理解性和可操作性方面均获得了近乎完美的分数。
逐步的语言/文化改编过程产生了一种以患者为中心的指南，对于在美国接受放射治疗的西班牙语患者来说，具有适当的可读性、可理解性和可操作性。未来的工作应包括临床医生和患者对 CEBRE en español 的外部评估。所描述的方法可以应用于医学其他领域和其他语言的以患者为中心的沟通资源的改编，作为提供公平医疗保健的跨专业方法的一部分。
