Clinician Rating Version
Activity
During the last week‚ the patient
• has been working or studying full-time or nearly so‚ in usual occupation; or managing own household; or participating in unpaid or voluntary activities‚ whether retired or not (2)
• has been working or studying in usual occupation or managing own household or participating in unpaid or voluntary activities; but requiring major assistance or a significant reduction in hours worked or a sheltered situation or was on sick leave (1)
• has not been working or studying in any capacity and not managing own household (0)
Daily living
During the last week‚ the patient
• has been self-reliant in eating‚ washing‚ toileting and dressing; using public transport or driving own car (2)
• has been requiring assistance (another person or special equipment) for daily activities and transport but performing light tasks (1)
• has not been managing personal care nor light tasks and/or not leaving own home or institution at all (0)
Health
During the last week‚ the patient
• has been appearing to feel well or reporting feeling “great” most of the time (2)
• has been lacking energy or not feeling entirely “up to par” more than just occasionally (1)
• has been feeling very ill or “lousy‚” seeming weak and washed out most of the time or was unconscious (0)
Support
During the last week
• the patient has been having good relationships with others and receiving strong support from at least one family member and/or friend (2)
• support received or perceived has been limited from family and friends and/or by the patient’s condition (1)
• support from family and friends occurred infrequently or only when absolutely necessary or patient was unconscious (0)
Outlook
During the past week the patient
• has usually been appearing calm and positive in outlook‚ accepting and in control of personal circumstances‚ including surroundings (2)
• has sometimes been troubled because not fully in control of personal circumstances or has been having periods of obvious anxiety or depression (1)
• has been seriously confused or very frightened or consistently anxious and depressed or unconscious (0)
How confident are you that your scoring of the preceding dimensions is accurate? Please ring [circle] the appropriate category.
Absolutely confident (1)‚ Very confident (2)‚ Quite confident (3)‚ Not very confident (4)‚ Very doubtful (5)‚ Not at all confident (6)
Self-assessment
Activity
What is your “main” activity?
1. I work full-time (or nearly so) in my usual occupation or study full-time (or nearly so) or manage my own household or take part in as much unpaid or voluntary activity as I wish‚ whether retired or not.
2. I work or study in my usual occupation or manage my own household or participate in unpaid or voluntary activities; but I need a lot of help to do so or I work greatly reduced hours.
3. I do not work in any capacity‚ nor do I study‚ nor do I manage my own household.
Daily living
Ability to look after yourself.
1. I am able to eat‚ wash‚ go to the toilet and dress without assistance. I drive a car or use public transport without assistance.
2. I can travel and perform daily activities only with assistance (another person or special equipment) but can perform light tasks.
3. I am confined to my home or an institution and cannot manage personal care or light tasks at all.
Health
What is your state of health?
1. I feel well most of the time.
2. I lack energy or only feel “up to par” some of the time.
3. I feel very ill or “lousy” most of the time.
Support
What support do you receive from others?
1. I have good relationships with others and receive strong support from at least one family member and/or friend.
2. The support I receive from family and friends is limited.
3. The support I receive from family and friends occurs infrequently or only when absolutely necessary.
Outlook
How do you feel about your life?
1. I am basically a calm person. I generally look forward to things and am able to make my own decisions about my life and surroundings.
2. I am sometimes troubled and there are times when I do not feel fully in control of my personal life. I am anxious and depressed at times.
3. I feel frightened and completely confused about things in general.
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Suissa‚ S.‚ Shenker‚ S.C.‚ Spitzer‚ W.O. (1984). Measuring the quality of life of cancer and chronically ill patients: cross-validation studies of the Quality of Life Index. [Manuscript] Montréal‚ Québec: Department of Clinical Epidemiology‚McGill University.
Wood-Dauphinee‚ S.‚ Williams‚ J.I. (1991). The Spitzer Quality-of-Life Index: its performance as a measure. In: Osoba D‚ ed. Effect of cancer on quality of life. Boca Raton‚ Florida: CRC Press‚ 1991:169–184.
Spitzer‚ W.O. (1988). Quality of life. In: Burley D‚ Inman WHW‚ eds. Therapeutic risk: perception‚ measurement‚ management. New York: John Wiley & Sons‚ 35–46.
Addington-Hall‚J.M.‚ MacDonald‚ L.D. & Anderson‚ H.R. (1990). Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care? Br. J. Cancer‚ 62‚ 695-699
McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS