Iterative Adaptation and Acceptability Testing of the Serious Illness Conversation Guide for Use with Mandarin-speaking Patients

Background: Serious illness conversations (SICs) help clinicians understand patients’ values, goals, and care preferences. The Serious Illness Conversation Guide (SICG) is a structured tool designed to support these discussions. However, no Mandarin-language version of the SICG has been adapted for use in Singapore, where many older adults speak only Mandarin and/or Chinese dialects, hindering SIC initiation. Aim: To document the iterative refinement of a culturally adapted Mandarin-language SICG and assess its acceptability among Mandarin-speaking patients with advanced cancer or heart failure. Design: The Mandarin-language SICG was translated from a locally adapted English version and tested in two interview-based rounds ( n = 25), followed by a survey-based acceptability assessment ( n = 51). Revisions were made between rounds based on qualitative feedback and quantitative ratings. Finalization was guided by two study-specific criteria: ≥75% rating each item “Very Acceptable” and ≥95% rating each item “Acceptable” or “Very Acceptable.” Setting/Participants: Outpatient clinics at the National Cancer Center Singapore and National Heart Center Singapore. Participants included patients with advanced cancer ( n = 41) or heart failure ( n = 35) (total n = 76). Results: Qualitative findings highlighted the prevalence of health anxieties and sensitivities around future care goals and prognostic disclosures. The final Guide was revised to address these challenges and achieved high acceptability. Participants strongly preferred the final version (median rating 4/4; p < 0.001 for most items). Conclusions: The finalized Mandarin-language SICG is a culturally appropriate tool that can facilitate meaningful, sensitive discussions in serious illness care in Singapore and potentially in the wider region.