Physical | I have a lack of energy |
I have nausea. | |
Because of my physical condition, I have trouble meeting the needs of my family. | |
I have pain. | |
I am bothered by side effects of treatment. | |
I feel ill. | |
I’m forced to spend time in bed. | |
Social | I feel close to my friends. |
I get emotional support from my family. | |
I get support from my friends. | |
My family has accepted my illness. | |
I am satisfied with family communication about my illness. | |
I feel close to my partner (or the person who is my main support). | |
I am satisfied with my sex life (option to not answer). | |
Emotional | I feel sad. |
I am satisfied with how I am coping with my illness. | |
I am losing hope in the fight against my illness. | |
I feel nervous. | |
I worry about dying. | |
I worry that my condition will get worse. | |
Functional | I am able to work (include work at home). |
My work (include work at home) is fulfilling. | |
I am able to enjoy life. | |
I have accepted my illness. | |
I am sleeping well. | |
I am enjoying the things I usually do for fun. | |
I am content with the quality of my life right now. |