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Copyright 1991 Charles S. Cleeland, PhD Pain Research Group All rights reserved PLEASE USE BLACK INK PEN Subject's Initials : _____ PI: _____ Protocol #: _____
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npcrc.orgCapital Health Guidelines for using the Edmonton Symptom Assessment System (ESAS) CH-0373 Mar 2001 Regional Palliative Care Program Purpose of the ESAS This tool is designed to assist in the assessment of …
The Brief Pain Inventory - NPCRC
npcrc.org25) I take my pain medicine (in a 24 hour period): 1. Not every day 4. 5 to 6 times per day 2. 1 to 2 times per day 5. More than 6 times per day
Brief Fatigue Inventory - NPCRC
npcrc.orgDate: / / Time:_____ Name:_____ _____ _____ Last First Middle Initial Brief Fatigue Inventory
HAMILTON DEPRESSION RATING SCALE - NPCRC
npcrc.orgThe total Hamilton Depression (HAM-D) Rating Scale provides and indication of depression and, over time, provides a valuable guide to progress. • Classification of symptoms which may be difficult to obtain can be scored as:
Caregiver Strain Index (CSI) - NPCRC
npcrc.orgCaregiver Strain Index (CSI) I am going to read a list of things that other people have found to be difficult. Would you tell me whether any of these apply to you?
McGILL QUALITY OF LIFE QUESTIONNAIRE - NPCRC
npcrc.orgMcGILL QUALITY OF LIFE QUESTIONNAIRE STUDY IDENTIFICATION #: DATE: Instructions The questions in this questionnaire begin with a statement followed by two opposite answers. Numbers extend from one extreme answer to its opposite. Please circle the number between 0 and 10 which is most true for you. There are no right or wrong answers.
Geriatric Depression Scale (GDS) Short Form - NPCRC
npcrc.orgScoring for Geriatric Depression Scale • Score 1 point for every “yes” in questions 2, 3, 4, 6, 8, 9, 10, 12, 14, 15 • Score 1 point for every “no” in ...
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