Question | Response | Construct | Source |
---|---|---|---|
a1. Considering all parts of your life – physical, emotional, social, spiritual, and financial – over the past two days, how would you rate your quality of life? | 0-10 scale | QOL- Global | |
Very Bad (0) | |||
Excellent (10) | |||
2. Over the past two days, how much have you been bothered by physical problems such as pain, upset stomach or difficulty breathing? | Not at all | QOL- Physical | Modified from Dartmouth COOP “Feelings” Chart [43] |
Slightly | |||
Moderately | |||
Quite a bit | |||
Extremely | |||
3. Over the past two days, how much have you been bothered by emotional problems such as feeling anxious, depressed, irritable, or downhearted and blue? | Not at all | QOL- Emotional | Dartmouth COOP “Feelings” Chart [43] |
Slightly | |||
Moderately | |||
Quite a bit | |||
Extremely | |||
4. Over the past two days, how much have you been bothered by uncertainty about what to expect from the course of your illness? | Not at all | QOL- Prognostic Uncertainty | Modified from Dartmouth COOP Chart (“Bothered by”) [43] and “what to expect from the course of my illness” [63] |
Slightly | |||
Moderately | |||
Quite a bit | |||
Extremely | |||
5. Over the past two days, how much have you felt at peace? | Completely | QOL- Spiritual | Modified from Peace Screening Item [64] |
Quite a bit | |||
Moderately | |||
Slightly | |||
Not at all | |||
a6. Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff? | Completely | Perceptions of Patient-Centered Communication | Modified from the Healthcare Climate Questionnaire [65] and the Patient Perceptions of Patient-Centeredness Questionnaire [36, 66] |
Quite a bit | |||
Moderately | |||
Slightly | |||
Not at all | |||
7. – 10. Gender (including transgendered), Ethnicity, Race, Education | |||
11. When you think about the amount of income that you have available in a typical month, how often is it enough for things you really need like food, clothing, medicine, repairs to the home, and transportation? | All of the time | Financial Strain | Modified from VOICE Study [49] |
Most of the time | |||
Some of the time | |||
None of the time | |||
12. How well does the following statement describe you? “In uncertain times, I tend to expect the best.” | Completely | Dispositional Optimism | |
Quite a bit | |||
Moderately | |||
Slightly | |||
Not at all | |||
13. What religions, if any, do you maintain a connection with? (Please check all that apply) | Christianity, Judaism, Islam, Hinduism, Buddhism, Other, No formal religious affiliation | Identity with Religion | VOICE Study [49] |
14. How much are your spiritual needs being supported by a religious community (like clergy or members of a congregation)? | Completely | Spiritual Support- Religious | Coping with Cancer Study [69] |
Quite a bit | |||
Moderately | |||
Slightly | |||
Not at all | |||
15. How much are your spiritual needs being supported by the medical system (doctors, nurses and chaplains)? | Completely | Spiritual Support- Medical | Coping with Cancer Study [69] |
Quite a bit | |||
Moderately | |||
Slightly | |||
Not at all | |||
16. How would you describe the purpose of your current medical care? Would you say | Yes | Perceptions of Treatment Purpose | Temel Study [23] |
No | |||
Don’t know | |||
A. “to help you live longer?” | (for each a-c) | ||
B. “to help you feel better?” | |||
C. “to get rid of all the cancer?” | |||
17. Would you say that it is likely or unlikely that you will live for a year or longer? | Very Likely | Self-Reported Life Expectancy | Adapted from Diefenback [70] |
Likely | |||
Unlikely | |||
Very Unlikely | |||
No idea | |||
18. How strongly do you agree or disagree with the following statement? | Strongly Agree | End of Life Treatment Preferences | |
Somewhat Agree | |||
Not sure | |||
“During the last few months of my life, I would prefer a plan of treatment that focused on my comfort and quality of life, even if that meant not living quite as long.“ | Somewhat Disagree | ||
Strongly Disagree |