Author on Call

The function of the “Author on Call” blog is to allow our readers and authors to interact with each other in a unique way. A few select authors will be chosen to share on the blog aspects of their papers that were especially meaningful to them personally or points that may not have made it into their published report. Readers will then have the opportunity to provide comments and questions, to which the authors will respond.

At times, as seen in our first entry, we will also post separate entries to the blog on various special topics that we feel would be informational or that we welcome your feedback on.

Tuesday, June 20, 2017

"There is no word for malnutrition in Dutch."

Translation and Cultural Adaptation of the Scored Patient-Generated Subjective Global Assessment: An Interdisciplinary Nutritional Instrument Appropriate for Dutch Cancer Patients

Martine J. Sealy, MSc, RD; Ulrike Haß, MSc, RD; Faith D. Ottery, MD, PhD; Cees P. van der Schans, PhD, PT; Jan L.N. Roodenburg, DDS, MD, PhD; Harriët Jager-Wittenaar, PhD, RD

"There is no word for malnutrition in Dutch. For our research, we needed an instrument to assess malnutrition in patients with head and neck cancer, and the versatile PG-SGA seemed a good option. However, it was originally developed in English for the American cultural setting and it was not available in Dutch. At first I thought: how different could the Dutch setting be from the American setting? But then it hit me… To begin with, there is no word for malnutrition in Dutch. There is a word for undernutrition, and a word for overnutrition, but these words do not cover exactly the same load as the word malnutrition. This made us decide that we needed a translation of the PG-SGA that included cultural adaptation. The journey that followed led to some surprising eye-openers. A Dutch patient that is asked whether he uses nutritional supplements, is probably thinking of his vitamin pill in the morning. He may not think of the unopened bottle of sip feeding in his fridge, which the PG-SGA refers to.

When I had no experience with the PG-SGA, and first read the following question:  "How would you rate the status of the interosseous muscles – 0=no loss, 1=mild loss, 2=moderate loss, 3=severe loss", it was incomprehensible to me, because I never heard of the term interosseous. Once this was clarified, I did comprehend the question, but I still thought it was difficult. To answer it, I needed knowledge of the human muscle anatomy and the skills to distinguish between "no loss", "mild loss", "moderate loss" and "severe loss".  It was surprising how much extra information was generated by discriminating between comprehensibility and difficulty. By including questions regarding comprehensibility and difficulty of the PG-SGA during the pilot test in cancer patients and healthcare professionals, we gained deeper insight in what items are considered comprehensible, implying the formulation is clear, and what items are considered difficult, implying a need for more knowledge and/or training.

The article Translation and Cultural Adaptation of the Scored Patient-Generated Subjective Global Assessment: An Interdisciplinary Nutritional Instrument Appropriate for Dutch Cancer Patients is the result of our cross-cultural journey. We are very excited that this study is published in Cancer Nursing, because the PG-SGA encourages an interdisciplinary approach to nutritional care. Nurses have a valuable role, because they are often in charge of the nutritional screening process, and, if needed, often initiate involvement of other professionals. As a result of our enthusiasm for the benefits of combining translation with cultural adaptation, my supervisor, Dr. Harriët Jager-Wittenaar, together with the developer of the PG-SGA, Dr. Faith Ottery, started to provide guidance from the PG-SGA/Pt-Global Platform (www.pt-global.org), to include cultural adaptation in translation projects for the PG-SGA into other languages and/or cultures. Shortly after the Dutch version, the Portuguese version of the PG-SGA was developed in collaboration with the Platform. Currently, for example Brazilian-Portuguese, German, Italian, Norwegian, Polish, and Thai versions of the PG-SGA are being developed and will become available as well."

—Ms. Martine Sealy on the paper " Translation and Cultural Adaptation of the Scored Patient-Generated Subjective Global Assessment: An Interdisciplinary Nutritional Instrument Appropriate for Dutch Cancer Patients," published ahead-of-print on the CANCER NURSING Web site. The full article may be viewed with a subscription.