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Table 3 Issues and discrepancies identified and revised during an Expert Group review (n = 11)

From: Translation and cultural adaptation of IPOS (integrated palliative care outcome scale) in Estonia

Original English IPOS question/item Discussion within Expert Group Expert Group resolution
Period of time – Over the past 3 days/week within a questionnaire Both “during” and “over” of the past 3 days/week were used in back translations. BT3 – use “over” as also in original IPOS.
Q2 scale item 4 “Overwhelmingly” Item was translated as “äärmiselt tugevalt”- it was discussed and proposed that “väga tugevalt” would be more appropriate to express the “overwhelmingly “in Estonian. Translation of IPOS in Estonian and back translation modified. Translation to Estonian changed (from “äärmiselt tugevalt”- to “väga tugevalt”). Because of this change also the back translation modified (from “extremely strongly” to “very strongly”) to deliver the meaning the “overwhelmingly” in Estonian.
Q2 listed symptom “Shortness of breath” Item was translated as “hingeldus”- it was discussed that “õhupuudus” would express more clearly the “shortness of breath”. Translation of IPOS in Estonian modified (from “hingeldus” to “õhupuudus”) to deliver clearly the meaning the of “shortness of breath” in Estonian.
Q2 listed symptom “Nausea (feeling like you are going to be sick)” Original IPOS has an additional note (feeling like you are going to be sick) added in brackets, which is not appropriate in Estonian context. “Iiveldus” is a clear definition and additional clarification in brackets is not needed it would be rather confusing. Translation of IPOS in Estonian modified (definition in brackets removed as N/A), because of this also back translation modified accordingly (text in brackets removed).
Q2 listed symptom “Poor appetite” Item was translated as “isutus” which can also mean no appetite at all. It was discussed that “söögiisu vähenemine” would be more correct translation to express the “Poor appetite”. Translation of IPOS in Estonian modified (from “isutus” to “söögiisu vähenemine”). Because of this change also the back translation modified (from “loss of appetite” to “decreased appetite”).
Q2 listed symptom “Poor mobility” Item was translated as “raskendatud liikumine” during the meeting was discussed that “liikumisraskused” would be more accurate term for “Poor mobility” in Estonian. Translation of IPOS in Estonian changed from “raskendatud liikumine” to “liikumisraskused”. Because of this change also back translation changed from “difficulty in moving” to “moving difficulties”.
Scale: 2 Sometimes Item was translated as “vahetevahel”. Same item was challenging also during FT. During the meeting was discussed that “aeg-ajalt” would express better the meaning of “sometimes” in Estonian. Translation of IPOS in Estonian changed (from “vahetevahel” to “aeg-ajalt” to better deliver the meaning of the “sometimes” in Estonian.
Q3. Have you been feeling anxious or worried about your illness or treatment? It was noticed and discussed that back translation did not include word “feeling”. No changes needed- translation in Estonian is correct and question is well understood so no further modification required.
Q5. Have you been feeling depressed? It was noticed and discussed that back translation did not include the word “feeling”. No changes needed- translation in Estonian is correct and question is well understandable so no further modification required.
Q6. Do you think s/he has felt at peace? The question was translated as “Kas arvate, et ta on olnud rahulik?” It was discussed that translation is too direct and rather express the physical status, not spiritual wellbeing and feeling of being at peace. Several suitable terms were discussed. It was agreed that “sisemine rahu”- in English “inner peace” express the question most correctly in Estonian. Both patient and staff versions in Estonian and back translation were updated. The question in patient version re-worded from “Kas arvate, et ta on olnud rahulik” to “Kas arvate, et ta on tundnud sisemist rahu?”
Back-translation modified from “Do you think he/she has been calm?” to “Do you think s/he has felt inner peace?”
Q6. Have you felt at peace? Question was translated as “Kas olete olnud rahulik?" It was discussed that translation is too direct and rather express the physical status not spiritual wellbeing and feeling of being at peace. Question modified from from “Kas olete olnud rahulik?" to “Kas olete tundnud sisemist rahu?” Back translation modified from “Have you been calm?” to “Have you felt inner peace?”
Q9. Have any practical problems resulting from your illness been addressed? (such as financial or personal)
3 Problems hardly addressed
Item has been translated as “probleemidega on vähesel määral tegeletud”- it was discussed that “probleemidega on vähe tegeletud” would be clearer sentence. Translation of IPOS in Estonian “Probleemidega on vähesel määral tegeletud?” changed to “Probleemidega on vähe tegeletud”.
If you are worried about any of the issues raised on this questionnaire then please speak to your doctor or nurse During the discussion and review was pointed out that translation to Estonian “Kui olete mures selles küsimustikus tõstatatud probleemide pärast, palun rääkige oma arsti või meditsiiniõega” is missing “any”. Translation of IPOS in Estonian modified from “Kui olete mures selles küsimustikus tõstatatud probleemide pärast, palun rääkige oma arsti või meditsiiniõega” to “Kui olete mures ükskõik millise küsimustikus tõstatatud probleemi pärast, palun rääkige oma arsti või meditsiiniõega”.
Back translation modified from “If you are worried about the issues raised in this questionnaire, please talk to your doctor or nurse” to “If you are worried about any of the issues raised in this questionnaire, please talk to your doctor or nurse”.
  1. Source: author, except the Original IPOS question/item (Palliative care Outcome Scale (POS). https://pos-pal.org/maix/)