Development and linguistic validation of the German "Multidimensional Impact of Cancer Risk Assessment" (MICRA) questionnaire.

The identification of hereditary cancer syndromes enables adapted therapy, preventive measures, and the identification of additional family members at risk. Genetic testing, however, is often associated with psychosocial stress, underscoring the need for reliable patient-reported outcome measures (PROMs). The 25-item Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire captures the psychosocial impact of genetic test result disclosure, including distress and uncertainty. As no German version was available, we aimed to develop a linguistically validated translation of MICRA and explored the potential of AI-based translation tools as support in the translation process. The linguistic validation followed the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, including two independent forward translations, reconciliation, back-translation, expert review, and final proofreading for the creation of a preliminary German version for pilot testing. Cognitive debriefing interviews were conducted in November 2024 with 10 counselees undergoing genetic counseling and testing for hereditary breast and ovarian cancer at Hannover Medical School (June 2023-July 2024). The translation process resulted in a German MICRA version that was well understood by the pilot testing group. None of the participants required assistance when completing the questionnaire. Issues raised by two or more participants, such as the similarity of certain response options, were evaluated but ultimately did not lead to changes. The translated version was also compared with outputs from ChatGPT-4o and DeepL Translator, with a focus on items that also required discussion among human translators. Both models missed contextual or emotional nuances in those cases, underscoring current limitations of AI in complex translation tasks. Still, they hold promise as supportive tools when combined with expert review. Overall, this study provides the first linguistically validated German version of the MICRA questionnaire, offering a valuable resource for assessing psychosocial outcomes in genetic counseling and research.