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Symptom Assessment Tools

Symptom Assessment Tools Order Form

To obtain permission to use this assessment tool, you must agree not to alter it in any way or to translate it into another language. You will be sent a PDF file of the tool and a letter of authorization via e-mail.

Fees may apply. If your request generates an invoice, please allow 7-10 business days for processing.

If your request is urgent or if the language version you seek is not shown, please contact Lori F. Smith to make special arrangements:

The Department of Symptom Research
Attn: Lori F. Smith
The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard, Unit 1450
Houston, Texas 77030
(713) 745-3805

 

Choose an Assessment Tool

Indicate your choice of assessment tool. To order additional tools, complete this form again.

Brief Pain Inventory (BPI)

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  • 4 pain severity items: worst, least, average, now
  • 7 pain interference items: general activity, walking, work, mood, enjoyment of life, relations with others, sleep
  • Bodily pain diagram
  • Current pain medications and percent relief achieved
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  • All items from BPI
  • Demographic information
  • Detailed description of current pain medications and percent relief achieved
  • Verbal pain descriptors

Brief Fatigue Inventory (BFI)

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  • 3 fatigue severity items: now, usual, worst
  • 7 fatigue interference items: general activity, mood, walking ability, normal work, relations with others, enjoyment of life

M. D. Anderson Symptom Inventory (MDASI)

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  • 13 symptom severity items: pain, fatigue, nausea, disturbed sleep, distress (emotional), shortness of breath, lack of appetite, drowsiness, dry mouth, sadness, vomiting, difficulty remembering, and numbness or tingling
  • 6 symptom interference items: general activity, mood, walking ability, normal work, relations with other people, and enjoyment of life
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  • 13 core MDASI symptom severity items
  • 6 core MDASI symptom interference items
  • 9 brain–tumor–specific symptom items: weakness on one side of the body, difficulty understanding, difficulty speaking, seizures, difficulty concentrating, vision, change in appearance, change in bowel pattern (diarrhea or constipation), and irritability
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  • 13 core MDASI symptom severity items
  • 6 core MDASI symptom interference items
  • 9 symptom items relevant to head and neck cancer: mucus in the mouth and throat, difficulty swallowing/chewing, choking/coughing, difficulty with voice/speech, skin pain/burning/rash, constipation, problems with tasting food, mouth/throat sores, and problems with teeth or gums
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  • 13 core MDASI symptom severity items
  • 6 core MDASI symptom interference items
  • 6 thyroid–cancer–specific symptom items: hoarseness, feeling hot, feeling cold, racing heartbeat, difficulty swallowing, and diarrhea
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  • 13 core MDASI symptom severity items
  • 6 core MDASI symptom interference items
  • 8 heart–failure–specific symptom items: abdominal bloating, ankle swelling, difficulty sleeping without adding more pillows under the head, lack of energy, nighttime cough, waking up at night with difficulty breathing, and sudden weight gain