The Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study: Anglicisation and initial validation of the FACE-Q Skin Cancer Module in a UK cohort

  • Thomas D. Dobbs
    Corresponding author at: Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK.
    Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK

    Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
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  • Maarten Ottenhof
    Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands

    Patient-Reported Outcomes, Value and Experience (PROVE) Centre, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA

    Department of Surgery, Harvard Medical School, Boston, MA, USA
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  • John A.G. Gibson
    Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK

    Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
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  • Iain S. Whitaker
    Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK

    Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
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  • Hayley A. Hutchings
    Health Services Research, Patient & Population Health & Informatics Research Group, Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
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Published:October 09, 2020DOI:


      Facial skin cancer is common, and its treatment affects patient's health-related quality of life (HRQoL), as demonstrated by patient-reported outcome measures (PROMs). In this study, we anglicise and validate the novel FACE-Q Skin Cancer Module for the UK population.
      Anglicisation of the FACE-Q Skin Cancer Module followed international guidance for cross-cultural adaptation. Cognitive interviews were performed, producing a reconciled and harmonised version for validation. Patients undergoing facial skin cancer excision were prospectively recruited and asked to complete the anglicised FACE-Q Skin Cancer Module, along with the Skin Cancer Index (SCI) and European Quality of Life-Five Dimensions (ED-5D) questionnaire, pre-operatively and 6–8 weeks post-operatively. Data were analysed using classical test theory. Ethical approval was obtained (REC: 16/WM/0445).
      One hundred and ten patients were recruited between August 2017 and July 2018. Internal consistency was high (Cronbach's alpha 0.867–0.967). All subscales had a single-factor solution using principal component analysis. Construct validity, as measured between the FACE-Q subscales and SCI subscales, was good, with >75% of a priori predictions confirmed. Pearson's r for item–total correlation was >0.80 for several items, and significant ceiling effects are shown in 7 of the 10 subscales, suggesting some item redundancy.
      The UK version of this well-designed PROM demonstrates good face and construct validity. There is however a degree of redundancy within the scales, and further work using Rasch analysis on a larger sample will help address this.


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