# The Chinese version of the autonomy preference index for advanced cancer patients: a study on cultural adaptation based on cognitive interview

## TL;DR

This study adapts a tool to measure advanced cancer patients' autonomy preferences for use in China, improving medical care quality.

## Contribution

A culturally adapted Chinese version of the Autonomy Preference Index (API) was developed and validated for advanced cancer patients.

## Key findings

- Cognitive interviews identified and resolved ambiguities in 5 API items, improving clarity for Chinese patients.
- The revised Chinese API has 23 items across two dimensions and was validated for accurate understanding.
- The tool now provides healthcare professionals an effective way to assess patient autonomy preferences in China.

## Abstract

The global cancer burden is becoming increasingly severe. In the context of patient-centred medicine, respecting patients’ autonomy and preferences is of paramount importance. However, there is currently a lack of scientific tools in China to measure the autonomous preferences of advanced cancer patients. We aim to optimise assessment tools for patients’ autonomous preferences and validate their effectiveness, thereby filling a gap in related research, in hopes of improving the quality of medical care in China.

① To assess the semantic clarity of entries of the Chinese Autonomy Preference Index (API) and determine whether patients can accurately comprehend their content. ② To validate the application effect of cognitive interviews in the translation of the scale into the Chinese culture and context.

In March and April 2023, we selected 17 advanced cancer patients by convenience sampling in Zunyi, Guizhou, China, to participate in this study. We assessed their understanding of each item in the Chinese API scale through cognitive interviews and made the corresponding revisions to the scale items based on the interview results.

The respondents’ understanding of various API entries after translation and adaptation was assessed. Based on the interview results, ambiguous entries were revised to create a refined Chinese version of the API. Ultimately, the API comprises two dimensions and 23 entries. The results of the first round of interviews revealed doubts or ambiguities in the semantic expression and understanding of 5 items, which were then revised following discussions by the research team. The second round of interviews confirmed that the interviewees could correctly understand the content of the entries without further modifications.

① Cognitive interviews can address discrepancies in the understanding of scale items among the target population and mitigate measurement errors stemming from item content ambiguity. ② Targeted questionnaire revisions have improved the accuracy, reliability, and applicability of the Chinese version of the API questionnaire. The Chinese version of the Autonomy-Preference-Index offers clinical healthcare professionals an effective measurement tool to assess the autonomous preferences of advanced cancer patients.

The online version contains supplementary material available at 10.1186/s40359-025-02391-y.

• The Autonomy Preference Index (API) has been extensively utilised in various populations outside of China, such as primary care patients and mental illness patients.• Respecting patient autonomy preferences is a vital component in enhancing the quality of medical care.• In a patient-centred medical environment, nurses play a crucial role in safeguarding patients’ autonomous preferences.

• The Autonomy Preference Index (API) has been extensively utilised in various populations outside of China, such as primary care patients and mental illness patients.

• Respecting patient autonomy preferences is a vital component in enhancing the quality of medical care.

• In a patient-centred medical environment, nurses play a crucial role in safeguarding patients’ autonomous preferences.

The online version contains supplementary material available at 10.1186/s40359-025-02391-y.