Quality of Life Forms Bank

Last Updated May 10, 2013 10:45:25

Disclaimer: Assessment tool is not intended for distribution. User assumes all risks related to the use of any information provided in the qol forms bank. Data available on all instruments are provided 'as is'.

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Instrument Scoring Algorithm Reliability/Validity Norms Other Documents
The FACT Tools         
ACS Caregiver QOL         
ADS Questionnaire         
Anorexia Questionnaire         
Anticipatory Grief Scale         
Arthritis Impact Measurement Scales 2 - Short         
Assessment of Survivor Concerns         
Asthma QOL Questionnaire - English Version         
Asthma QOL Questionnaire - University of Sydney         
Barthel Index of Activities of Daily Living        ADL_info.pdf 
Basic Needs Satisfaction Inventory (BNSI)         
Beck Depression Index  BDI.txt       
Beck Depression Index - II         
Beck Hopelessness Index         
Body Image Scale         
Bone Mineral Density (BMD) Results Form         
Bowel Function Questionnaire  BFQ.txt       
Breakthrough Pain Assessment         
Breast Cancer Treatment Outcomes Questionnaire         
Breast Pain Questionnaire         
Breast-Q (Mastectomy Module)         
Brief Edinburgh Depression Scale         
Brief Fatigue Inventory    BFI_VR.doc     
Brief Food Questionnaires-English         
Brief Food Questionnaires-French         
Brief Pain Inventory  BPI_sco.pdf  BPI_VR.doc    BPI_info.pdf 
Brief Pain Inventory (NCCTG Breast Pain version)         
Brief Pain Inventory (NCCTG standard version)         
Burden Interview (CBI)    Burden_VR.doc  CBI_Info.htm   
CARES - Short Form  CARES-SF_sco.txt  CARES-SF_VR.doc     
CRQ - Original - First Administration         
CRQ - Original - Follow Up         
CRQ - Self Administered - First Administration  CRQ-SAS_sco.pdf      CRQ-SAS_info.pdf 
CRQ - Self Administered - Follow Up  CRQ-SAS_sco.pdf      CRQ-SAS_info.pdf 
Cancer Worry Scale        CWS_info.pdf 
Cardiff Wound Impact Schedule         
Caregiver QOL (Assessment of Patient)         
Caregiver QOL (Assessment of Self)         
Caregiver QOL - Cancer  CQOLC-Scoring.pdf       
Caregiver QOL Self-Assessment         
Caregiver Quality of Life Index         
Center for Epidemiologic Studies Depression Scale         
Center for Epidemiologic Studies Depression Scale  CESD_sco.pdf       
Chaplain End of Life Questionnaire         
Charlson Co-Morbidity Index    CCI_VR.pdf    CCI_VR2.pdf 
Childbirth Expectations Questionnaire         
Cognitive Capacity Screening Evaluation (CCSE)         
Comfort Care-EOL        COMCARE_GEN_info.pdf 
Comfort Care-General Care        COMCARE_GEN_info.pdf 
Complementary and Integrative Medicine Outcome Scales  CIMOS_sco.pdf  CIMOS_VR.pdf    CIMOS_info.pdf 
Completion Questions-English         
Completion Questions-French         
Constructed Meaning Scale         
Control Preferences Scale    Control_VR.doc     
Coop Wonca    COOPW_VR.doc  COOPW_info.pdf   
Cough-Specific QOL Questionnaire    CQLQ_VR.doc     
Death/Suicide Rating Scale    DeathSuic_VR.doc  DeathSuic_Info.htm   
Delighted-Terrible Scale         
Demands of Illness Inventory  DOII.txt       
Drug use Questionnaire         
Duke Religion Index (DUREL)    DUREL_VR.doc     
Duke Severity of Illness Checklist (DUSOI)         
Duke Social Support and Stress Scale - Form A         
Duke Social Support and Stress Scale - Form B         
ECOG CTC for Sensory Neuropathy         
EORTC Chemotherapy-Induced Peripheral Neurophathy Module  CINP20_sco.pdf      CIPN20_sco.txt 
EORTC QLQ Brain Module         
EORTC QLQ Gastrointestinal Neuroendocrine Tumor Module         
EORTC QLQ Lung Module         
EPIC + AUA Symptom Index + SF12  EPIC_sco.sas  EPIC-2_VR.pdf    EPIC-sco.pdf 
EPIC-Bowel  EPIC_sco.sas  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC-sco.pdf 
EPIC-Demographic  EPIC_sco.sas  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC-sco.pdf 
EPIC-Hormonal  EPIC_sco.sas  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC-sco.pdf 
EPIC-Sexual  EPIC_sco.sas  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC-sco.pdf 
EPIC-Urinary  EPIC_sco.sas  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC-sco.pdf 
Edmonton Symptom Assessment: Graph         
Edmonton Symptom Assessment: Numeric         
Edmonton Symptom Assessment: Visual Analogue         
Epworth Sleepiness Scale  Epworth_sco.pdf       
Euro QOL (EQ-5D)  EQ5D_sco.sas      EPIC_info.pdf 
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oeophageal module         
European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire  EORTC_sco.pdf    EORTCQLQ30_norms.pdf  QLQ.txt 
Exercise Behaviors  Ex_Beh_Scoring.pdf       
Fagerstrom Test for Nicotine Dependence  Fagerstrom.txt       
Family Care Satisfaction Questionnaire         
Family Inventory Needs         
Fatigue Symptom Inventory  FSI_sco.pdf      FSI_info.pdf 
Female Sexual Function Index  FSFI_sco.pdf      FSFI_info.pdf 
Ferrell Patient QOL         
Folstein Mini Mental Status Exam  MMSE_sco.pdf  MMSE_VR.doc    MMSE_info.pdf 
Folstein Mini Mental Status Exam (Spanish)  MMSE_sco.pdf  MMSE_VR.doc    MMSE_info.pdf 
Frailty Index         
Functional Alterations due to Changes in Elimination        FACE_info.pdf 
Functional Assessment of side-effects on EGFR inhibitors        FAST-EGFR_info.pdf 
Functional Living Index - Emesis (3 Days)         
Functional Living Index - Emesis (5 Days)         
Functional Living Index: Cancer (FLIC)         
Functional Outcomes of Sleep Questionnaire (FOSQ)  FOSQ_sco.pdf       
Functional Performance Inventory (FPI)         
Gastrointestinal Symptom Rating Scale         
General Health Questionnaire (GHQ)    GHQ_VR.txt     
General Self-Efficacy Scale         
Geriatric Depression Scale - Long Form  GDS_long_sco.pdf      GDS_oth_lang.pdf 
Geriatric Depression Scale - Short Form  GDS_sf_sco.pdf      GDS_oth_lang.pdf 
Global Happiness Item         
Global Rating of Change         
Global Rating of Change Scale         
Global Satisfaction Survey         
Godin Leisure-Time Exercise Questionnaire  GLTEQ_scoring.pdf       
Habitual Physical Activity  HPA_sco.pdf      HPA_info.pdf 
Happiness Profile         
Head and Neck Quality of Life Questionnaire         
Health Locus of Control Scale  HLC.pdf       
Health Status Questionnaire         
Health Utilities Index         
Healthy Days Measure         
High Sensitivity Cognitive Screen         
Hospice Quality of Life Index-Revised 1998         
Hospital Anxiety and Depression Scale         
Hot Flash Diary         
Hot Flash Diary Version 2         
Hot Flash Related Daily Interference Scale         
Illness Distress Scale (IDS)  IDS.txt       
Impact of Events Scale         
Impact of Treatment Scale  ITS_sco_CODE.txt       
International Index of Erectile Function        IIEF_info.pdf 
International Physcial Activity Questionnaire Long Last 7 Days Self-Administered        IPAQ_info.pdf 
International Physical Activity Questionnaire Long Last 7 Days Telephone        IPAQ_info.pdf 
International Physical Activity Questionnaire Short Last 7 Days Self-Administered        IPAQ_info.pdf 
International Physical Activity Questionnaire Short Last 7 Days Telephone        IPAQ_info.pdf 
Interpersonal Patient-Provider Relationship Scale         
Interpersonal Reactivity Index         
Jefferson Scale of Physician Empathy (JSPE)         
Karnofsky Performance Score (ECOG)         
Kid-KINDL (Children's Questionnaire)      Kid-KINDL-Manual.pdf   
Kiddy-KINDL-Interview (Children's Questionnaire)      Kid-KINDL-Manual.pdf   
Kidney Disease QOL Instrument         
Kingsley Alopecia Profile Instrument         
LASA    LASA_VR.doc     
LASA - Industry         
LASA 10         
LASA 4 (as in Study N0147)-English         
LASA 4 (as in Study N0147)-French         
LASA Neuropathy         
LASA Spanish version    LASA_VR.doc     
LASA5 plus Anxiety         
Leg and Foot Ulcer Questionnaire         
Likert Scale for Significant Others         
Liver Transplant         
Locke-Wallis Marital Adjustment Test        LMAT_info.pdf 
Lubben Social Networks Scale (LSNS)  LSS.txt       
Lung Cancer Symptom Scale         
Lymphedema Symptom Survey Instrument         
Lymphedema and Breast Cancer Questionnaire         
MD Anderson Symptom Inventory (MDASI)    MDASI_VR.doc     
MDASI-Head and Neck        MDASI-HN_info.pdf 
MacNew QOL After Myocardial Infarction         
Maslach Burnout Inventory  MBI_sco.pdf       
Maugeri Foundation Respiritory Failure Questionnaire         
Mayo Hospice Questionnaire         
McGill Nausea Questionnaire (MNQ)         
McGill Pain Questionnaire (MPQ)      MPQ_Info.pdf   
McGill Quality of Life Questionnaire (MQOL)        MQOL_info.pdf 
Memorial Symptom Assessment    MSAS_VR.doc     
Menopause-Specific Quality of Life Questionnaire        MENQOL_info.pdf 
Menopause-Specific Quality of Life-Intervention Questionnaire        MENQOL_INT_info.pdf 
Mental Adjustment to Cancer Scale (MAC)      MAC_Manual.doc   
Mental Health Continuum Short Form  MHC-SF_sco.pdf  MHC-SF_VR.pdf    MHC-SF_info.pdf 
Mini - Mental Adjustment to Cancer Scale (MAC)         
Minnesota Leisure Time Physical Activity Scale         
Morrow Assessment of Nausea and Emesis        MANE_info.pdf 
Motor Vehicle Accidents         
Multidimensional Body-Self Relations Questionnaire - Appearance Orientation Subscale         
Multidimensional Fatigue Symptom Inventory  FSI_sco.pdf      FSI_info.pdf 
Multidimensional Fatigue Symptom Inventory-Short form  FSI_sco.pdf      FSI_info.pdf 
Multidimensional Quality of Life Scale - Cancer2         
Myelofibrosis Symptom Assessment Form        MFSAF_info.pdf 
NCCN Distress Management Form         
NCCTG Anorexia Survey         
NCCTG Patient Bowel Function Questionnaire         
NCCTG Patient Questionnaires (Colon Cancer)-English         
NCCTG Patient Questionnaires (Colon Cancer)-French         
NCI Quick Food Scan         
NCIC Nausea and Vomiting Tool        nausea_vomiting_bg.doc 
Nepean Dyspepsia Index (NDI)         
Nepean Dyspepsia Index - Short Form         
Nottingham Health Profile         
Numeric Pain Intensity Scale        NPIS_oth_languages.pdf 
OARS Multidimensional Assessment         
Obesity Adjustment Survey         
Obesity Related Problem Scale         
Occupational Exposures         
Oncology Nursing Society Fatigue Scale         
Ostomy QOL Form         
PMH/PSQ-MD 29         
PROMIS Global Health Short Form  PSGLOBAL_sco1.pdf      PSGLOBAL_sco2.sas 
PTSD Checklist-Civilian Version (PCL-C)         
Pain Catastrophizing Scale  PAINCS_scoring.pdf  PAINCS_validity.pdf     
Palliative Care Caregiver Survey         
Palliative Care Patient Survey         
Palliative Medicine Symptom Assessment         
Patient Health Questionnaire 2         
Patient Health Questionnaire 9    PHQ-9_VR.pdf     
Patient-Oriented Prostate Utility Scale         
Patient-Physician Concordance CPS    CPSv2_VR.doc     
Patient-Reported Oral Mucositis Symptom (PROMS) Scale    PROMS_VR.pdf     
Pediatric Quality of Life Inventory - Child Report (Age 8-12)        PEDSQL.pdf 
Pediatric Quality of Life Inventory - Parent Report for Child (Age 8-12)        PEDSQL.pdf 
Perceived Stress Scale-10 items  PSS_sco.pdf       
Perceived Stress Scale-14 items  PSS_sco.pdf       
Perceived Stress Scale-4 items  PSS_sco.pdf       
Performance Status Scale for Head and Neck Cancer Patients        PSS-HN_info.pdf 
Pharmacist End of Life Knowledge Assessment         
Philadelphia Geriatric Center Morale Scale         
Physician End of Life Knowledge Assessment         
Piper Fatigue Scale    PFS_VR.doc     
Pittsburgh Sleep Quality Index  PSQI_sco.pdf       
Positive States of Mind Scale         
Positive and Negative Affect Schedule        PANAS_info.pdf 
Positive and Negative Affect Schedule        PANAS_O_info.pdf 
Postoperative Quality of Life    PQL_VR.pdf     
Profile of Moods Scale (POMS)  POMS_SF.txt  POMS_VR.doc     
Profile of Moods Scale (POMS) - Revised Version  POMS_SF.txt  POMS_VR.doc     
Profile of Moods Scale - POMS Long Form  POMS_LF.txt       
Pruritus Questionnaire         
Pruritus-specific QOL        ITCHY-QOL_info.pdf 
Psychological Adjustment to Illness Scale-Caregiver      PAIS_Info.pdf   
Psychological Adjustment to Illness Scale-Self      PAIS_Info.pdf   
Psychological Distress Inventory (PDI)         
Quality of Life - Faces         
Quality of Life Scale         
RN/LVN End of Life Knowledge Assessment         
Registration Fatigue Assessment         
Registration Uniscale Assessment         
Revised Dyadic Adjustment Scale  RDAS_sco.pdf       
Rhodes Index of Nausea,Vomiting, and Retching        nausea_vomiting_bg.doc 
Rosenberg Self-Esteem Scale  RSES.pdf      RSE.pdf 
SF-10 for Children Health Survey      SF-10-User.pdf   
SF-12 Health Survey (Standard)  SF-12.txt       
SF-12 Health Survey (scannable version)         
SF-36 (Version 2)         
SF-36 Health Survey  SF-36.txt  SF-36_VR.doc     
SF-36 Health Survey (Acute)         
SF-8 Health Survey - 24-hour recall         
SF-8 Health Survey - acute (1-week recall)  SF-8.pdf       
SF-8 Health Survey - standard (4-week recall)         
SF12-Health Survey (Spanish version)  SF-12.txt       
Satisfaction with Life Scale         
Scale of QOL of Caregivers         
Seattle Angina Questionnaire         
Seattle Obstructive Lung Disease Questionnaire         
Sexual Adjustment Questionnaire (SAQ)        SAdjQ_info.pdf 
Short-Form McGill Pain Questionnaire         
Sickness Impact Profile  SIP.pdf       
Social Workers End of Life Knowledge Questionnaire         
Spiritual Well Being  SWB.txt       
Spitzer Quality of Life Index        SQLI_info.pdf 
St. George's Respiratory Questionnaire      SGRQ_Manual.doc   
Stages of Change  SC_sco.pdf       
State Trait Anxiety Inventory (Forms Y-1 and Y-2)  STAI_ScoreKey.pdf  STAI_VR.doc  STAI_Norms.pdf   
Subject Global Impression of Change         
Subjective Happiness Scale         
Suffering Index         
Surgical Outcomes Measurement System-Anxiety Short Form         
Surgical Outcomes Measurement System-Depression Short Form         
Symptom Checklist-90-Revised         
Symptom Distress Scale (SDS)  SDS.txt  SDS_VR.doc  SDS_Background.pdf   
Symptom Distress Scale (SDS) - Mayo Version         
Symptom Experience Diary         
The Expanded Prostate Cancer Index Composite (EPIC)  EPIC-sco.pdf  EPIC-2_VR.pdf  EPIC-2_norms.pdf  EPIC_info.pdf 
The Expanded Prostate Cancer Index Composite - Short Form  EPIC-26_sco.sas       
The Greene Climacteric Scale         
The Head and Neck Symptom Scale of the Uni. of Washington QOL Scale        UWHNSS_info.pdf 
The Health-Promoting Lifestyle Profile        HPLP_info.pdf 
The Seattle Angina Questionnaire         
The Serenity Scale        SERENITY_info.pdf 
The Uni. of Michigan Xerostomia-Related QOL Scale        XeQOLS_info.pdf 
Toolkit of Instruments to measure End of Life (Hospice version)         
Toolkit of Instruments to measure End of Life (Hospital version)         
Toolkit of Instruments to measure End of Life (Nursing Home version)         
Uniscale Assessment - Bar         
Uniscale Assessment - Linear Analogue         
Urogenital Atrophy Questionnaire  UAQ_sco.docx    UAQ_sco_CODE.txt   
WHO Classification Scale (Neuropathy)         
Was It Worth It (WIWI) Questionnaire         
Weight Monitoring Records         
Wong-Baker FACES Pain Rating Scale        WONG_FACES_info.pdf 
Yale-Brown Single Item         
Zung Self Rating Depression Scale  ZungScore.pdf