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EMOTIONAL AND COGNITIVE SYMPTOMS For the purpose of this conference,
we have divided physical and emotional symptoms into two separate domains.
This was purely an administrative decision. It should be noted that
research has shown that physical and emotional symptoms are indeed strongly
related. Physical symptoms in a terminal illness are associated with
emotional distress, depression, and anxiety. An important question is
whether we recommend a separate instrument for emotional symptoms such
as anxiety and depression, or if we recommend an instrument that measures
pain, depression, anxiety, and other symptoms. Based on a review of
the literature, we have listed both sets of instruments. Note that the
instruments that focus on emotional symptoms are listed first, followed
by those for general symptoms. BAI Beck Anxiety Inventory (Beck et al. 1988) is a 21 item self-administered instrument which measures symptoms associated with anxiety and was used on patients with cancer pain (Portenoy et al.1999). BDI Beck Depression Index (Beck 1961) - a widely used scale that measures the severity of depression by evaluating 21 symptoms. A short form of the BDI (BDI-SF) consisting of 13 items was used in a study of terminally ill patients (Chochinov et al. 1998). BECOMO The Bernese Coping Mode (Heim et al. 1993) this instrument allows an observer to rank behavioral, cognitive or emotion-oriented symptoms on a 5-point Likert scale. BECOMO has been used on breast cancer patients (Heim et al. 1997). Brief Symptom Inventory (Derogatis and Melisaratos 1983) - is a 53-item self-report scale which has been used in a study which looked at the barriers to pain management in ambulatory AIDS patients (Breitbart et al 1998). CAM Confusion Assessment
Method Diagnostic Algorithm (Inouye et al. 1990) includes four
features: acute onset and fluctuating course, inattention, disorganized
thinking, and altered level of consciousness. This instrument was utilized
in a study on elderly patients with delirium (Mussi et al 1999). General Health Questionnaire (Goldberg 1972) - a self-administered instrument designed to detect depression, anxiety, social impairment, and hypochondriasis Geriatric Depression Scale (Yesavage 1983)- simple scale developed to diagnose depression in older persons. Hospital Anxiety and Depression Scale (Zigmond 1983) - a self-assessment scale with depression and anxiety subscales. A computerized version was utilized in a study which compared paper and computer touch-screen questionnaires (Velikova et al 1999). IES Impact of Event Scale (Zilberg et al. 1982) this instrument measures the stress encountered when faced with a difficult life event and has been employed in a study on breast cancer patients (Spiegel et al. 1999). IQCODE The Informant Questionnaire on Cognitive Decline in the Elderly (Jorm and Jacomb, 1989) this questionnaire which, is administered by a proxy, measures the fall from higher to lower intellectual level. IQCODE has been utilized in a study of cognitive impairment in medical inpatients (Harwood et al. 1997). In addition, there is a short form of the IQCODE (Jorm 1994). LCS Life Closure Scale (Dobratz 1990) - is a 45 item which measures the psychological adaptation during the dying process consists of three subscales: self-reconciled, self-reconstructing, and self-closing. MAC Mental Adjustment to Cancer Scale (Watson et al., 1988) - is a 40 item instrument that measures fighting spirit, anxious preoccupation, helpless-hopelessness and fatalism. MAC was utilized in a study examining the concept of coping (Nordin et al. 1999). Mental Health Inventory (Ware 1979) - used in Kane and colleagues' randomized controlled trial of hospice. This instrument has been shortened to five questions (the MHI-5, Berwick 1991). MDAS Memorial Delirium Assessment Scale (Breitbart et al. 1996) is a 10 item four-point clinician-rated scale which measures awareness, disorientation, short-term memory impairment, impaired digit span, shift attention, disorganized thinking, perceptual disturbance, delusions, psychometric activity, and disorder of arousal. New Social Desirability Scale (Koller et al. 1999) a 12 item scale where patients answer question regarding social desirability with yes or no. PAS Psychiatric Assessment Schedule (Bond et al. 1980) is a 51 item instrument which has a section to identify organic disorders, affective disorders and psychoneuroses, and schizophrenias and paranoid disorders. PAS was employed in a study examining the physical and psychological needs of patients with colo-rectal cancer (Maguire et al. 1999). PASS Pain Anxiety Symptoms Scale (McCracken et al. 1992) this is a 62-item questionnaire which measures cognitive symptoms, physiological symptoms and motor responses and includes four subscales that measure fear of pain, cognitive anxiety, somatic anxiety and escape and avoidance. PASS has been used on patients with cancer pain (Turk et al. 1998). Profile of Mood States (Cella 1987) - a 65-item, adjective rating scale used in the National Hospice Study and The Study to Understand Prognoses and Preferences for Outcomes, and Risks of Treatments. There is also a shortened version of the POMS which consists of 11 items (Cella et al 1987) which was employed in a study looked at reducing distress in cancer patients with an orientation program (McQuellon et al 1998). PSE Present State Examination (Wing et al. 1974) - is a semi-structured interview which assesses the present mental state and has been used in a study examining questionnaires for detecting anxiety and depression in breast cancer patients (Hall et al. 1999). RDCQ Reactions to the Diagnosis of Cancer Questionnaire (Stromberg-Frank 1989) is a 28 item instrument which measures confronting reactions and distress reactions (to the diagnosis). RDCQ was used on patients diagnosed with gastrointestinal cancer (Nordin and Glimelius 1998). Self-rating Depression Scale (Zung 1965) this is a 20 item self-administered instrument. This instrument has been used in a study which looks at depression in chronic medical diseases (Leung et al 1998). SPMSQ Short Portable Mental Status Questionnaire (Pfeiffer 1975) is an observer-rated 10 item instrument that assesses orientation, memory, and concentration and has been used on diagnosing delirium in the elderly (Zou et al. 1998). SQ The Symptom Questionnaire (Kellner 1987 ) is a 92 item instrument that determines (using a yes/no format) anxiety, depression, hostility, and somatization and has been employed in a study of breast cancer patients (Giraldi et al. 1997). STAI State-Trait Anxiety Inventory (Spielberger et al. 1970) is a self-administered instrument that measures the present and anxiety of patients and has been used on hospice patients (Heaven 1997). Starck P (1983) - is a 20-item scale that used to evaluate patient's views of the meaning of suffering. This instrument was used in a study that analyzed cancer patients' experiences of suffering (Kuuppelomaki and Lauri 1998). SUPPORT The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments Afterdeath interview (Lynn 1996) - It should be noted that there is an important debate on how to handle physical/somatic symptoms in depression scales. I have predominately listed scales which focus on the measure of psychological symptoms, given that the assessment of physical symptoms will be an important part of the "toolkit". Symptom Anxiety and Depression Scale (Bedford 1976). The UCLA-Loneliness Scale (Russell 1980) is a 20 item questionnaire which measures satisfaction with social relationships and feelings of loneliness. This scale has been used in a study of breast cancer patients (Giraldi et al. 1997). Well-Being Scale (Giasson, 1994) this is a self-administered visual analogue scale that measures pain, nausea, depression, anxiety, shortness of breath, activity, appetite, relaxation, and inner peace. Instruments that assess
multiple symptoms: Dartmouth COOP Functional Assessment Charts (Nelson 1996) - quick, easily administered survey that relies on visual images to assess multiple domains. DqoL Dementia Quality of Life Instrument (Brod et al. 1999) is a 29 item instrument that measures self esteem, positive affect/humor, negative affect, feelings of belongings, and sense of aesthetics. Edmonton Symptom Assessment System (Bruera 1991) - a scale comprised of eight visual analogue scales indicating various physical and emotional symptoms. EORTC QLQ (Anderson 1993) - an instrument created for cancer patients incorporating nine multi-item scales. Memorial Symptom Assessment Scale (Portenoy 1994) - a patient rated instrument to provide information on symptom prevalence, characteristics and distress. The Quality of Life Index (Spitzer 1981) - a scale designed to measure the general well-being of patients with terminal illness or chronic disease. Rotterdam Symptom Checklist (de Haes 1990) - a self-administered scale that includes an eight item subcale for psychological distress. SSQ Subjective Significance Questionnaire (Osoba et al. 1998) this is a 7-category scale measuring perceived physical, emotional, social functioning, and global quality of life. Support Team Assessment Schedule
(Butters 1992) - instrument that requires staff and patient to evaluate
symptoms and needs.
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