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Leaving the Lab: Lessons Learned in Cognitive Testing of Tobacco Use Questions in a Clinical Setting
Jennifer Crafts, Westat; Stephanie Land, National Cancer Institute; Gordon Willis, National Cancer Institute; Veronica Chollette, National Cancer Institute; Jasmine Folz, Westat; Dorothy Hatsukami, Masonic Cancer Center - University of Minnesota; Jamie Ostroff, Memorial Sloan Kettering Cancer Center; Graham Warren, Medical University of South Carolina; Benjamin Toll, Yale School of Medicine; Sonia Duffy, The Ohio State University; Thomas Brandon, H. Lee Moffitt Cancer Center
Introduction
The objective of this study was to test and revise a hard copy self-administered questionnaire for use with cancer patients and survivors. To date, tobacco use by cancer patients has been an under-studied area. Cancer researchers have needed of a set of standard longitudinal measures of tobacco use, so as to investigate the relationship between tobacco use and the effectiveness of a broad variety of cancer treatments and therapies.
This poster provides similarities and differences between (1) a typical cognitive interviewing study conducted in a lab environment and (2) a study we conducted in a clinical context. We note factors that qualitative researchers may want to consider when conducting research in realistic contexts.
Members of the National Cancer Institute (NCI) American Association for Cancer Research (AACR) Cancer Patient Tobacco Use Assessment Task Force drafted the initial set of items based on their expertise in tobacco use measurement for the cancer patient population.

2. Lab Study vs. “Real world” NCI Study
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3. Lab Study vs. “Real world” NCI Study
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4. Lab Study vs. “Real world” NCI Study
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5. Lab Study vs. “Real world” NCI Study
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6. Results Recommendations
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Results
The three rounds of testing the questionnaire identified a variety of issues with item wording, reference periods, format, order, response options, and instructions. Revisions improved navigation, question comprehension, and response accuracy.
Interview results provided support for construct validity of the questionnaire.
Recommendations
To enhance realism and acceptance of cognitive interviewing results, test with representatives of the intended population within the expected administration setting.
When planning a “real-world” cognitive interviewing study, researchers should plan carefully and consider:
More stringent data security procedures may apply for the testing setting and population.
There are likely to be deviations from standard lab-based study procedures for contacting, screening, and scheduling participants.
Time requirements at each study stage or testing round may vary,
Depending on subject population, the time requirement for testing larger number of subjects may be avoided (OMB approval not applicable); and
Approval time for instrument and/or protocol changes between rounds may be longer.