Bridging the language gap in palliative oncology: A translation and validation of the Urdu version of EORTC’s QLQ-C15-PAL.

Abstract

e24049 Background: The World Health Organization (WHO) estimates that around 56.8 million people require palliative care each year, while only 7.9 million receive it, demonstrating a significant gap in the provision of palliative care. Lower-middle-income countries (LMICs) suffer disproportionately from this care gap, leading to decreased access to palliative care. One potential intervention to improve access to palliative care is translating tools into native languages, making them more accessible to local populations. Urdu is the tenth most widely spoken language worldwide, popularly spoken in South Asia and around the world with immigrants from the region. In this study, we aim to translate the EORTC’s QLQ-C15-PAL tool into Urdu and validate it in the Pakistani population. Methods: First, the C15-PAL questionnaire was translated into Urdu. For validation, a cross-sectional study was conducted in the Aga Khan University Hospital in Karachi, Pakistan on 100 consenting adults admitted under the palliative service. In addition to the C15-PAL Urdu questionnaire, Edmonton Symptom Assessment System Revised (ESAS-r) and the Palliative Performance Score (PPS) were administered. To test the reliability of multi-item scales, Cronbach α coefficient was used. Pearson correlation coefficients were used to test construct and concurrent validity while student-t test was used to evaluate known-group validity. Ethics Review Committee (ERC) approval was obtained (2024-9120-31586). Results: In the preliminary analysis of 53 patients (53%), the C15-PAL Urdu had an α coefficient of 0.8713. Subscales were also tested, with physical function (1-3), pain (5, 12), fatigue (7, 11), emotional functioning (13, 14) demonstrating an α coefficient of 0.9277, 0.8257, 0.6867, 0.8808 respectively (Table). All correlation coefficients between the items and subscales were noted to exceed the set value of 0.40. Concurrent validity of the questionnaire was tested by correlating C15-PAL Urdu scales with ESAS, resulting in numerous significant correlations, notable exception being “best wellbeing”. Known-group validity was evaluated by comparing median and above PPS scores against C15-PAL, showing that patients with higher PPS scores reported significantly better overall quality of life, emotional and physical functioning, and lower levels of fatigue. Conclusions: Our results demonstrate that overall, the EORTC Urdu questionnaire is reliable and valid. As a result, it can be self-administered to Urdu speaking patients. Cronbach’s alpha coefficients for each subscale in the Urdu EORTC C15-PAL. Physical functioning (items 1-3) 0.9277 Pain (items 5,12) 0.8257 Fatigue (items 7,11) 0.6867 Emotional functioning (items 13,14) 0.8808 Overall 0.8713 Cronbach’s alpha > 0.7 demonstrates reliability.