Overcoming language barriers to enhance pharmaceutical care: Design and validation of a pictogram-based tool for cancer patients

Purpose Oncology Pharmacists providing care for cancer patients need access to medication history, act to prevent drug- / herb-drug interaction (HDI), educate patients on detection and management of adverse effects (AE) through proper use of supportive care. However, language barriers are common in case with less spoken languages, making communication challenging. We aimed to design and validate a set of illustrations addressing these key topics. Methods The design of the pictures was led by three pharmacists, focusing on three topics: general information (medication history), problems detection (AE of anticancer treatments, HDI) and the proper use of supportive care (e.g., mouthwash). Illustrations were created using Canva ® (Canva Pty Ltd, Perth, Australia). Each card underwent a two-step validation process: an on-site evaluation (Wooclap ® (Bruxelles, Belgium) for agreement/disagreement with recommendations), followed by a broader validation involving a multidisciplinary panel including oncologists, general practitioners, nurses, pharmacists, and patients- using a 9-point Likert scale on a Google ® Form (Google, Mountain View, CA, USA). Results A total of 53 cards were initially evaluated by 19 pharmacists who fully approved 18 of them and provided recommendations for the others. Subsequently, a panel of 27 respondents rated the 53 cards. After the first round, the mean score was 7.37 ± 1.2, with all but five cards receiving a score >6 and being validated. The clarity of four cards (weight variation, HDI, dry skin, neuropathy) was improved while one (St John's wort) was ultimately removed. The four revised cards were then resubmitted and received approval. Conclusions A final set of 52 validated cards will help enhance pharmaceutical care for cancer patients facing language barriers.