ID

10165

Beschreibung

Copyright David Cella, Ph.D. Only academic use allowed, industry use requires a license. Terms of use and details see http://www.facit.org/

Link

http://www.facit.org/

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Versionen (1)
  1. 17.04.15 17.04.15 - Martin Dugas
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Copyright David Cella, Ph.D.

Hochgeladen am

17. April 2015

DOI

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Creative Commons BY-NC-ND 3.0
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FACT-G

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Functional Assessment of Cancer Therapy-General (Version 4)

1 Formulare  
Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days.
Beschreibung

Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days.

Patient ID
Beschreibung

Patient ID

Datentyp

text

Alias
UMLS CUI-1
C2348585
Assessment date
Beschreibung

Assessment date

Datentyp

date

Alias
UMLS CUI-1
C2985720
PHYSICAL WELL-BEING
Beschreibung

PHYSICAL WELL-BEING

Alias
UMLS CUI-1
C0517226
I have a lack of energy
Beschreibung

lack of energy

Datentyp

integer

Alias
UMLS CUI-1
C3830237
I have nausea
Beschreibung

nausea

Datentyp

integer

Alias
UMLS CUI-1
C0027497
Because of my physical condition, I have trouble meeting the needs of my family
Beschreibung

trouble meeting family needs

Datentyp

integer

Alias
UMLS CUI-1
C3830235
I have pain
Beschreibung

pain

Datentyp

integer

Alias
UMLS CUI-1
C0030193
I am bothered by side effects of treatment
Beschreibung

bothered by side effects

Datentyp

integer

Alias
UMLS CUI-1
C2984047
I feel ill
Beschreibung

feel ill

Datentyp

integer

Alias
UMLS CUI-1
C0231218
I am forced to spend time in bed
Beschreibung

forced to spend time in bed

Datentyp

integer

SOCIAL/FAMILY WELL-BEING
Beschreibung

SOCIAL/FAMILY WELL-BEING

Alias
UMLS CUI-1
C3476515
I feel close to my friends
Beschreibung

feel close to friends

Datentyp

integer

Alias
UMLS CUI-1
C2984048
I get emotional support from my family
Beschreibung

emotional support from family

Datentyp

integer

Alias
UMLS CUI-1
C2984050
I get support from my friends
Beschreibung

support from friends

Datentyp

integer

Alias
UMLS CUI-1
C3161725
My family has accepted my illness
Beschreibung

Family accepted illness

Datentyp

integer

Alias
UMLS CUI-1
C2984053
I am satisfied with family communication about my illness
Beschreibung

satisfied with family

Datentyp

integer

Alias
UMLS CUI-1
C2364309
I feel close to my partner (or the person who is my main support)
Beschreibung

feel close to partner

Datentyp

integer

Alias
UMLS CUI-1
C2984059
Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section
Beschreibung

no answer to sexual activity

Datentyp

boolean

I am satisfied with my sex life
Beschreibung

Satisfied with sex life

Datentyp

integer

Alias
UMLS CUI-1
C2984060
EMOTIONAL WELL-BEING
Beschreibung

EMOTIONAL WELL-BEING

Alias
UMLS CUI-1
C2984554
I feel sad
Beschreibung

feel sad

Datentyp

integer

Alias
UMLS CUI-1
C2987511
I am satisfied with how I am coping with my illness
Beschreibung

satisfied with coping with illness

Datentyp

integer

Alias
UMLS CUI-1
C2984061
I am losing hope in the fight against my illness
Beschreibung

losing hope

Datentyp

integer

Alias
UMLS CUI-1
C2984056
I feel nervous
Beschreibung

Feel Nervous

Datentyp

integer

Alias
UMLS CUI-1
C3536990
I worry about dying
Beschreibung

worry about dying

Datentyp

integer

Alias
UMLS CUI-1
C2984076
I worry that my condition will get worse
Beschreibung

worry about worsening condition

Datentyp

integer

Alias
UMLS CUI-1
C2984075
FUNCTIONAL WELL-BEING
Beschreibung

FUNCTIONAL WELL-BEING

Alias
UMLS CUI-1
C2984555
I am able to work (include work at home)
Beschreibung

able to work

Datentyp

integer

Alias
UMLS CUI-1
C2984044
My work (include work at home) is fulfilling
Beschreibung

work fulfilling

Datentyp

integer

Alias
UMLS CUI-1
C2984074
I am able to enjoy life
Beschreibung

enjoy life

Datentyp

integer

Alias
UMLS CUI-1
C2984051
I have accepted my illness
Beschreibung

accepted illness

Datentyp

integer

Alias
UMLS CUI-1
C2984045
I am sleeping well
Beschreibung

sleep well

Datentyp

integer

Alias
UMLS CUI-1
C2984071
I am enjoying the things I usually do for fun
Beschreibung

enjoy things

Datentyp

integer

Alias
UMLS CUI-1
C2984052
I am content with the quality of my life right now
Beschreibung

content with quality of life

Datentyp

integer

Alias
UMLS CUI-1
C2984049
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Ähnliche Modelle

Functional Assessment of Cancer Therapy-General (Version 4)

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days.
Patient ID
Item
Patient ID
text
C2348585 (UMLS CUI-1)
Date
Item
Assessment date
date
C2985720 (UMLS CUI-1)
Item Group
PHYSICAL WELL-BEING
C0517226 (UMLS CUI-1)
Item
I have a lack of energy
integer
C3830237 (UMLS CUI-1)
Lack of energy
Code List
I have a lack of energy
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I have nausea
integer
C0027497 (UMLS CUI-1)
Lack of energy
Code List
I have nausea
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
Because of my physical condition, I have trouble meeting the needs of my family
integer
C3830235 (UMLS CUI-1)
Lack of energy
Code List
Because of my physical condition, I have trouble meeting the needs of my family
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I have pain
integer
C0030193 (UMLS CUI-1)
Lack of energy
Code List
I have pain
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am bothered by side effects of treatment
integer
C2984047 (UMLS CUI-1)
Lack of energy
Code List
I am bothered by side effects of treatment
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I feel ill
integer
C0231218 (UMLS CUI-1)
Lack of energy
Code List
I feel ill
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am forced to spend time in bed
integer
Lack of energy
Code List
I am forced to spend time in bed
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item Group
SOCIAL/FAMILY WELL-BEING
C3476515 (UMLS CUI-1)
Item
I feel close to my friends
integer
C2984048 (UMLS CUI-1)
Lack of energy
Code List
I feel close to my friends
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I get emotional support from my family
integer
C2984050 (UMLS CUI-1)
Lack of energy
Code List
I get emotional support from my family
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I get support from my friends
integer
C3161725 (UMLS CUI-1)
Lack of energy
Code List
I get support from my friends
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
My family has accepted my illness
integer
C2984053 (UMLS CUI-1)
Lack of energy
Code List
My family has accepted my illness
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am satisfied with family communication about my illness
integer
C2364309 (UMLS CUI-1)
Lack of energy
Code List
I am satisfied with family communication about my illness
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I feel close to my partner (or the person who is my main support)
integer
C2984059 (UMLS CUI-1)
Lack of energy
Code List
I feel close to my partner (or the person who is my main support)
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Q1
Item
Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section
boolean
Item
I am satisfied with my sex life
integer
C2984060 (UMLS CUI-1)
Lack of energy
Code List
I am satisfied with my sex life
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item Group
EMOTIONAL WELL-BEING
C2984554 (UMLS CUI-1)
Item
I feel sad
integer
C2987511 (UMLS CUI-1)
Lack of energy
Code List
I feel sad
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am satisfied with how I am coping with my illness
integer
C2984061 (UMLS CUI-1)
Lack of energy
Code List
I am satisfied with how I am coping with my illness
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am losing hope in the fight against my illness
integer
C2984056 (UMLS CUI-1)
Lack of energy
Code List
I am losing hope in the fight against my illness
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I feel nervous
integer
C3536990 (UMLS CUI-1)
Lack of energy
Code List
I feel nervous
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I worry about dying
integer
C2984076 (UMLS CUI-1)
Lack of energy
Code List
I worry about dying
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I worry that my condition will get worse
integer
C2984075 (UMLS CUI-1)
Lack of energy
Code List
I worry that my condition will get worse
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item Group
FUNCTIONAL WELL-BEING
C2984555 (UMLS CUI-1)
Item
I am able to work (include work at home)
integer
C2984044 (UMLS CUI-1)
Lack of energy
Code List
I am able to work (include work at home)
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
My work (include work at home) is fulfilling
integer
C2984074 (UMLS CUI-1)
Lack of energy
Code List
My work (include work at home) is fulfilling
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am able to enjoy life
integer
C2984051 (UMLS CUI-1)
Lack of energy
Code List
I am able to enjoy life
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I have accepted my illness
integer
C2984045 (UMLS CUI-1)
Lack of energy
Code List
I have accepted my illness
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am sleeping well
integer
C2984071 (UMLS CUI-1)
Lack of energy
Code List
I am sleeping well
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am enjoying the things I usually do for fun
integer
C2984052 (UMLS CUI-1)
Lack of energy
Code List
I am enjoying the things I usually do for fun
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
Item
I am content with the quality of my life right now
integer
C2984049 (UMLS CUI-1)
Lack of energy
Code List
I am content with the quality of my life right now
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
CL Item
A little bit (1)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (2)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
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