DOMAIN | 21 ITEMS THAT UNDERWENT COGNITIVE INTERVIEWING | FINAL VERSION OF THE 21-ITEM SCREENER APPLICABLE ACROSS ALL CANCER AND TREATMENT TYPES |
---|---|---|
Agenda Setting for Visit | “What would you like to talk to nurse or doctor about today?”3 | What would you like to talk to nurse or doctor about today? |
Insomnia | What was the SEVERITY of your INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY) at its WORST?1 | Rate your worst insomnia (trouble sleeping). |
Decreased Appetite | What was the SEVERITY of your DECREASED APPETITE?1 | Rate your worst decreased appetite. |
Nausea | What was the SEVERITY of your NAUSEA at its WORST?1 | Rate your worst upset stomach. |
Pain Frequency | How OFTEN did you have PAIN?1 | How often did you have pain? |
Pain Intensity | What was the SEVERITY of your PAIN at its WORST?1 | Rate your worst pain. |
Depression | What was the SEVERITY of your SAD or UNHAPPY FEELINGS at their WORST?1 | Rate your worst sad or unhappy feelings. |
Fatigue | What was the SEVERITY of your FATIGUE, TIREDNESS, OR LACK OF ENERGY at its WORST?1 | Rate your worst tiredness, lack of energy, fatigue. |
Headache | What was the SEVERITY of your HEADACHE at its WORST?1 | Rate your worst headache. |
Anxiety | What was the SEVERITY of your ANXIETY at its WORST?1 | Rate your worst anxiety (worrying). |
Neuropathy | What was the SEVERITY of your NUMBNESS OR TINGLING IN YOUR HANDS OR FEET at its WORST?1 | Rate your worst numbness or tingling in your hands or feet. |
Dyspnea | What was the SEVERITY of your SHORTNESS OF BREATH?1 | Rate your worst shortness of breath. |
Cough | What was the SEVERITY of your COUGH at its WORST?1 | Rate your worst cough. |
Trouble Concentrating | What was the SEVERITY of your PROBLEMS WITH CONCENTRATION at their WORST?1 | Rate your worst problems with concentration. |
Diarrhea | How OFTEN did you have LOOSE OR WATERY STOOLS (DIARRHEA)?1 | How often did you have loose or watery stools (diarrhea). |
Loss of control of urine | How OFTEN did you have LOSS OF CONTROL OF URINE (LEAKAGE)? 1 | How often did you have loss of control of urine (leakage). |
Rash | Did you have any RASH?1 | Did you have a rash? (yes/no) |
Other Symptoms Not Listed | Did you have any other symptoms not listed?3 | Did you have any other symptoms not listed? |
Overall Health | In general, would you say your HEALTH is:2 Excellent, Very Good, Good, Fair, Poor? | In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor? |
Quality of Life | In general, would you say your QUALITY OF LIFE is:2 Excellent, Very Good, Good, Fair, Poor? | In general, would you say your quality of life is: Excellent, Very Good, Good, Fair, Poor? |
Daily Activities | To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?2 | To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? |
Notes:
PRO-CTCAE,
PROMIS Global Health Questionnaire,
Question Written by Authors.