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Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses

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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.

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Authors and Affiliations

  1. Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK

    N. W. Scott & P. M. Fayers

  2. Quality of Life Unit, European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium

    A. Bottomley

  3. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    N. K. Aaronson

  4. Division of Medical Oncology, Department of Internal Medicine, University Medical Centre, Utrecht, The Netherlands

    A de Graeff

  5. Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark

    M. Groenvold & M. A. Petersen

  6. Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

    M. Groenvold

  7. Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany

    M. Koller

  8. Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    M. A. G. Sprangers

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  1. N. W. Scott
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  2. P. M. Fayers
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  3. A. Bottomley
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  4. N. K. Aaronson
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  5. A de Graeff
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  6. M. Groenvold
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  7. M. Koller
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  8. M. A. Petersen
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  9. M. A. G. Sprangers
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on behalf of the EORTC and the Quality of Life Cross-Cultural Meta-Analysis Group

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Correspondence to P. M. Fayers.

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Scott, N.W., Fayers, P.M., Bottomley, A. et al. Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses. Qual Life Res 15, 1103–1115 (2006). https://doi.org/10.1007/s11136-006-0040-x

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