Family Quality of Life Questionnaire-Patient with Cancer
Wisawatapnimit‚ 2009
Family Quality of Life Questionnaire-–Patient Version
How satisfied are you with…
1. how willing family members are to help when someone in the family needs extra help?
2. the contact that family members have with each other in person‚ or on the phone‚ etc.?
3. the help that family members give each other in their lives?
4. how often family members do things together either at home or going out?
5. your sex life with your partner?
If this is not applicable or you prefer not to answer‚ please check this box
6. how willing family members are to care for someone who gets sick?
7. the help family members give each other around the house?
8. how your family shares responsibilities‚ such as taking care of children or pets‚ or shopping for food?
9. your family’s financial situation?
10.how your family handles the problems that come up?
11.how honestly your family discusses the future?
12.how family members show feelings such as sadness‚ happiness‚ or disappointment?
13.how optimistic or positive your family is?
14.the love and affection family members show each other?
15.how much family members encourage and support each other?
16.how family members show concern for each other?
17.how family members talk about important things that come up?
18.the time that your family spends with you?
How satisfied are you with…
1. how willing family members are to go with you to the doctor or the hospital?
2. how well family members find the time to take care of their own responsibilities as well as to help take care of you?
3. how well family members are able to adjust their own activities and work in response to your illness?
4. how well your family adjusts to changes in your activity level and abilities because of your cancer?
5. how openly your family talks about cancer‚ and your treatment and its side effects?
6. how family members share their feelings about your situation with cancer?
7. how often family members ask you how you are doing?
8. The encouragement and support that family members give you to help you cope with cancer?
9. how close your family members have become because of your cancer?
How satisfied are you with…
1. the interactions among family members (how family members relate to each other)?
2. the sharing of responsibilities in your family?
3. communication among members of your family?
4. the emotional support that people in your family give each other?
Overall‚ how satisfied are you with your family life?
Family Quality of Life Questionnaire-–Family Member Version
How satisfied are you with…
1. how willing family members are to help when someone in the family needs extra help?
2. the contact that family members have with each other in person‚ or on the phone‚ etc.?
3. the help that family members give each other in their lives?
4. how often family members do things together either at home or going out?
5. your sex life with your partner?
If this is not applicable or you prefer not to answer‚ please check this box
6. how willing family members are to care for someone who gets sick?
7. the help family members give each other around the house?
8. how your family shares responsibilities‚ such as taking care of children or pets‚ or shopping for food?
9. your family’s financial situation?
10.how your family handles the problems that come up?
11.how honestly your family discusses the future?
12.how family members show feelings such as sadness‚ happiness‚ or disappointment?
13.how optimistic or positive your family is?
14.the love and affection family members show each other?
15.how much family members encourage and support each other?
16.how family members show concern for each other?
17.how family members talk about important things that come up?
18.the time that your family spends with you?
How satisfied are you with…
1. how willing family members are to go the doctor or the hospital with the person who has cancer?
2. how well family members find the time to take care of their own responsibilities as well as to help take care of the family member with cancer?
3. how well family members are able to adjust their own activities and work in response to your family member’s illness?
4. how well your family adjusts to changes in the activity level and abilities of your family member who has cancer?
5. how openly your family talks about your family member’s cancer‚ treatment and its side effects?
6. how family members share their feelings about your family member’s cancer?
7. how often family members ask you how you are doing?
8. The encouragement and support that family members give each other to cope with the situation?
9. how close your family members have become because of the cancer?
How satisfied are you with…
1. the interactions among family members (how family members relate to each other)?
2. the sharing of responsibilities in your family?
3. communication among members of your family?
4. the emotional support that people in your family give each other?
Overall‚ how satisfied are you with your family life?
1-Not at All‚ 2-A Little‚ 3-Somewhat‚ 4-Quite a Bit‚ 5-Very Much
This instrument can be found online at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.475.7660&rep=rep1&type=pdf
Wisawatapnimit‚ Panarut. (2009). Assessment of Family Quality of Life Among Families with a Member who has Cancer. Vanderbilt University. Doctoral Dissertation