Table 2.

Sample cognitive interview responses

Content	Item stem	Response options	Patients’ comments about items (patients’ Age/Sex)	Example of…
Positive affect	I felt attentive	Not at all A little bit Somewhat Quite a bit Very much	“Same as question 22 (I felt cheerful). I have a wonderful life. I’m blessed to be here. I try to be cheerful and happy.” (69/M)	Poor understanding and logic
Life satisfaction	In most ways, my life is close to perfect	Strongly disagree Disagree Slightly disagree Neither agree nor disagree Slightly agree Agree Strongly agree	“Hard because of the word ‘perfect’. I don’t know how to answer it. What is perfection?” (59/F)	Difficult to answer
Meaning & purpose	I believe there is an ultimate meaning of life	Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree	“What exactly is an ‘ultimate meaning of life’? I have ethical and moral standards, but I don’t know if that’s an ultimate meaning. This one was very hard; I had no answer for it.” (70/M)	Partial understanding; difficult to answer
Self-efficacy	I can handle whatever comes my way	Never Almost Never Sometimes Fairly Often Very Often	“I have a circle of people to help me. I can think of cancer being the worst thing that came my way. I rely on people.” (81/F)	Full understanding and good logic