Description:

Z6051 Stoma Quality of Life Scale (SQOLS) NCT00726622 Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AD922C0-C82B-483B-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AD922C0-C82B-483B-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/26/15
Uploaded on:

June 26, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Z6051 Stoma Quality of Life Scale (SQOLS) NCT00726622

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  1. StudyEvent: Z6051 Stoma Quality of Life Scale (SQOLS)
    1. No Instruction available.
Patient demographics
Visit
Quality of life assessment
I am able to participate in hobbies that I enjoy
I do not enjoy eating out in public because of concerns regarding my stoma
I am able to go out with friends
I am able to perform the same duties at work/school
I worry about traveling because of my stoma
I enjoy sexual activity less because of my stoma
I feel less attractive because of my stoma
My sexual partner is not bothered by my stoma
I don't mind if others are aware I have a stoma
I feel attractive in my clothing
I am statisfied with the foods I eat
I have financial concerns regarding my ostomy supplies
I have problems with odor
I am embarrassed by gas (noises or rapid filling of bag)
I am worried my stoma will leak
I am bothered by skin irritation around the stoma
I manage the same responsibilities at home
Social situations make me feel anxious
I find an ostomy support group helpful
What effect has your stoma had on your quality of life

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