Skip to main content Accessibility help
×
Home
  • Print publication year: 2004
  • Online publication date: December 2009

12 - Assessing health-related quality of life at end of life

Summary

Assessment of health-related quality of life (HRQOL) at end of life (EOL) can be quite challenging. However, understanding how treatment affects HRQOL during the terminal phases of care is critical to providing the quality of cancer care called for by the National Cancer Policy Board (NCPB) of the Institute of Medicine. The stage at diagnosis, disease progression, and personal and social factors make cancer care at the end of life extraordinarily complex. Inevitably, as one approaches death, symptoms are dynamic and change in an unpredictable fashion, requiring rapid modifications in medications and other therapies. At this time, assessment of HRQOL, as well as patient management, are formidable tasks.

In studying terminally ill populations, it is important to articulate what is meant by palliative and “end of life” care. The World Health Organization (WHO) defines palliative care as the “active total care of patients whose disease is not responsive to curative treatments.” The NCPB has adopted the WHO definition of palliative care, but it also notes that palliative care should begin at the time of cancer diagnosis and extend through the course of the disease to the time of death. While palliative care and EOL care are often seen as equivalent, some make the distinction that EOL care is focused only on the terminal stage, whereas palliative care may extend throughout the disease trajectory. For purposes of this paper, palliative care and EOL care will be used interchangeably, per the WHO definition.

REFERENCES
Foley, K. M., Gelband, H. (ed.) (2001). Institute of Medicine and National Research Council: Improving Palliative Care for Cancer Summary and Recommendations. Washington, DC: National Academy Press
World Health Organization Division of Mental Health (1993). WHO-QOL Study Protocol: The Development of the World Health Organization Quality of Life Assessment Instrument (MNG/PSF/93.9). Geneva, Switzerland: World Health Organization
American Society of Clinical Oncology (1996). Outcomes of cancer treatment for technology assessment and cancer treatment guidelinesJournal of Clinical Oncology 14:671–9
Franks, P. J., Salisbury, C., Bosanquet, N.et al. (2000). The level of need for palliative care: a systematic review of the literaturePalliative Medicine 14(2):93–104
Holland, J. C., Chertkov, L. (2001). Clinical practice guidelines for the management of psychosocial and physical symptoms of cancer. In Institute of Medicine and National Research Council: Improving Palliative Care for Cancer Summary and Recommendations, ed. K. M. Foley, H. Gelband, pp. 7-1–7-60. Washington, DC: National Academy Press
McCahill, L., Ferrell, B. R., Virani, R. (2001). Improving cancer care at the end of lifeLancet Oncology 2:103–8
Cleeland, C. S. (2001). Cross-cutting research issues: a research agenda for reducing distress of patients with cancer. In Institute of Medicine and National Research Council: Improving Palliative Care for Cancer Summary and Recommendations, ed. K. M. Foley, H. Gelband, pp. 8-1–8-85. Washington, DC: National Academy Press
King, C. R., Hinds, P. S. (1998). Quality of Life from Nursing and Patient Perspectives: Theory, Research, Practice. Sudbury, MA: Jones and Bartlett Publishers, Inc
Breitbart, W., Payne, D. K. (1998). Pain. In Psycho-Oncology, ed. J. C. Holland, pp. 450–67. New York: Oxford University Press
Cherny, N. (1998). Cancer pain: principles of assessment and syndromes. In Principles and Practice of Supportive Oncology, ed. A. Berger, R. K. Portenoy, D. E. Weissman, pp. 3–43. Philadelphia, PA: Lippincott-Raven Publishers
Dean, G. E., Anderson, P. A. (2001). Fatigue. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 91–100. New York: Oxford University Press
Greenberg, D. B. (1998). Fatigue. In Psycho-Oncology, ed. J. C. Holland, pp. 485–93. New York: Oxford University Press
Portenoy, R. K. (2000). Physical symptom management in the terminally ill. In Handbook of Psychiatry in Palliative Medicine, ed. H. M. Chochinov, W. Breitbart, pp. 99–129. New York: Oxford University Press
Portenoy, R. K., Itri, L. M. (1999). Cancer-related fatigue: guidelines for evaluation and managementOncologist 4:1–10
Portenoy, R. K., Lesage, P. (1999). Management of cancer painLancet 353(9165):1695–700
Berger, A. M., Portenoy, R. K., Weissman, D. E. (1998). Principles and Practice of Supportive Oncology. Philadelphia, PA: Lippincott-Raven Publishers
Doyle, D., Hanks, G. W. C., MacDonald, E. (Ed.) (1998). Oxford Textbook of Palliative Medicine, (2nd edition). New York: Oxford University Press
National Comprehensive Cancer Network and American Cancer Society (NCCN/ACS) (2001). Patient Guidelines for the Treatment of Cancer Pain. Atlanta, GA: American Cancer Society
American Pain Society (APS) Quality Care Committee (1998). Quality improvement guidelines for the treatment of acute pain and cancer painJournal of the American Medical Association 274:1874–80
World Health Organization (1986). Cancer Pain Relief. Geneva, Switzerland: World Health Organization
World Health Organization (1996). Report of the WHO Expert Committee on Cancer Pain Relief and Active Supportive Care: Cancer Pain Relief with a Guide to Opioid Availability. Technical Series 804, 2nd edition. Geneva: World Health Organization
World Health Organization (1998). Symptom Relief in Terminal Illness. Geneva, Switzerland: World Health Organization
Cella, D. F. (1998). Quality of life. In Psycho-Oncology, ed. J. C. Holland, pp. 1135–46. New York: Oxford University Press
Cella, D. F., Tulsky, D. S., Gray, G.et al. (1993). The Functional Assessment of Cancer Therapy Scale: development and validation of the general measureJournal of Clinical Oncology 11:570–9
Ferrell, B. R. (1996). Pain: how patients and families pay the price. In Pain Treatment Centers at a Crossroads: A Practical and Conceptual Reappraisal. Progress in Pain Management, Vol. 7, ed. M. J. M. Cohen, J. N. Campbell, pp. 229–37. Seattle, WA: International Association for the Study of Pain
Ferrell, B. R. (1998). The family. In Oxford Textbook of Palliative Medicine (2nd edition), ed. D. Doyle, G. W. C. Hanks, N. MacDonald, pp. 909–17. New York: Oxford University Press
Ferrell, B. R., Borneman, T. (1999). Pain and suffering at the end of life (EOL) for older patients and their familiesGenerations XⅫI(1):12–17
Ferrell, B. R., Wisdom, C., Schneider, C. (1989). Quality of life as an outcome variable in the management of cancer painCancer 63:2321–7
Holland, J. C. (ed.) (1998). Psycho-Oncology. New York: Oxford University Press
Die-Trill, M. (1998). The patient from a different culture. In Psycho-Oncology, ed. J. C. Holland, pp. 857–66. New York: Oxford University Press
Die-Trill, M., Holland, J. C. (1993). Cross-cultural differences in the care of patients with cancer: A reviewGeneral Hospital Psychiatry 15:21–30
Payne, R. (2000). At the end of life, color still dividesThe Washington Post, February 15, p.15
Morris, J. N., Mor, V., Goldberg, R. J., Sherwood, S., Greer, D. S., Hiris, J. (1986). The effect of treatment setting and patient characteristics on pain in terminal cancer patients: a report of the national hospice studyJournal of Chronic Diseases 39(1):27–35
Morris, J. N., Suissa, S., Sherwood, S., Wright, S. M., Gree, D. (1986). Last days: a study of the quality of life of terminally ill cancer patientsJournal of Chronic Diseases 39(1):47–62
Davies, B. (2001). Supporting families in palliative care. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 363–73. New York: Oxford University Press
Ferrell, B. R. (2001). Pain observed: the experience of pain from the family caregiver's perspectiveClinics in Geriatric Medicine 17(3):595–609
Ferrell, B. R., Rivera, L. M. (1995). Cancer pain: impact on elderly patients and their family caregivers. In Chronic Pain in Old Age: An Integrated Biopsychosocial Perspective, ed. R. Roy. Toronto: University of Toronto Press
Ferrell, B. R., Rivera, L. M. (1997). Cancer pain education for patientsSeminars in Oncology Nursing 13(1):42–8
Emanuel, E. J., Fairclough, D. L., Slutsman, J., Emanuel, L. L. (2000). Understanding economic and other burdens of terminal illness: the experience of patients and their caregiversAnnals of Internal Medicine 132(6):451–9
Levine, C. (Ed.) (2000). Always on Call: When Illness Turns Families into Caregivers. New York: United Hospital Fund of New York
O'Connell, L. J. (1996). Changing the culture of dying. A new awakening of spirituality in America heightens sensitivity to the needs of dying personsHealth Progress 77(6):6–20
Steinhauser, K. E., Christakis, N. A., Clipp, E. C., McNeilly, M., McIntyre, L., Tulsky, J. A. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providersJournal of the American Medical Association 284(19):2476–82
Snyder, this volume, Chapter 16, pp. 329–345
Cella, D. F. (1995). Measuring quality of life in palliative careSeminars in Oncology 22(2 Suppl. 3):73–8
Breitbart, W., Jaramillo, J. R., Chochinov, H. M. (1998). Palliative and terminal care. Psycho-Oncology, ed. J. C. Holland, pp. 437–49. New York: Oxford University Press
Curt, G. A. (2000). Impact of fatigue on quality of life in oncology patientsSeminars in Hematology 37(4 Suppl. l6):14–17
Ferrell, B. R., Coyle, N. (2001). Textbook of Palliative Nursing. New York: Oxford University Press
Breitbart, W. C., Cohen, K. R. (1998). Delirium. In Psycho-Oncology, ed. J. C. Holland, pp. 564–75. New York: Oxford University Press
Bruera, E., Franco, J. J., Maltoni, M., Watanabe, S., and Suarez-Almazor, M. (1995). Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotationJournal of Pain and Symptom Management 10:287–91
Bruera, E., Miller, L., McCallion, J.et al. (1992). Cognitive failure in patients with terminal cancer: a prospective studyJournal of Pain and Symptom Management 7(4):192–5
Bruera, E., Neumann, C. M. (1998). Management of specific symptom complexes in patients receiving palliative careCanadian Medical Association Journal 158:1717–26
Chochinov, H. M., Breitbart, W. (Ed.) (2000). Handbook of Psychiatry in Palliative Medicine. New York: Oxford University Press
Walch, S. E., Ahles, T. A., Saykin, A. J. (1998). Neuropsychological impact of cancer and cancer treatment. In Psycho-Oncology, ed. J. C. Holland, pp. 500–8. New York: Oxford University Press
Breitbart, W. C., Wein, S. E. (1998). Metabolic Disorders and Neuropsychiatric Symptoms. In Psycho-Oncology, ed. J. C. Holland, pp. 639–52. New York: Oxford University Press
Passik, S. D., Breitbart, W. (1993). Psychiatric and psychological approaches to cancer pain. In Management of Cancer Pain, ed. E. Arbit, pp. 151–77. Mount Kisko, NY: Futura Publishing Company
Pereira, J., Hanson, J., Bruera, E. (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancerCancer 69:835–41
Ferrell, B. R., Grant, M., Rhiner, M., Padilla, G. V. (1992). Home care: maintaining quality of life for patient and familyOncology 6(2):136–40
Ferrell, B. R., Grant, M., Chan, J., Ahn, C., Ferrell, B. A. (1995). The impact of cancer pain education on family caregivers of elderly patientsOncology Nursing Forum 22(8):1211–18
Fox, B. H. (1998). Psychosocial factors in cancer incidence and prognosis. In Psycho-Oncology, ed. J. C. Holland, pp. 110–24. New York: Oxford University Press
Gavrin, J., Chapman, C. R. (1995). Clinical management of dying patientsWestern Journal of Medicine 163(3):268–77
Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., Piantadosa, S. (2001). The prevalence of psychological distress by cancer sitePsycho-Oncology 10:9–28
Zabora, J. R., Loscalzo, M. J. (1996). Comprehensive psychosocial programs: a prospective model of careOncology Issues 1:14–18
Benson, H. (1984). Beyond the Relaxation Response. New York: Times Books
Benson, H. (1996). Timeless Healing: The Power of Biology and Belief. New York: Simon and Schuster
Jenkins, R. A., Pargament, K. I. (1995). Religion and spirituality as resources for coping with cancerJournal of Psychosocial Oncology 13 (1/2):51–74
Johnston-Taylor, E. (2001). Spiritual Care: Nursing Theory, Research, and Practice. Upper Saddle River, NJ: Prentice Hall
Larson, D. B., Greenwold-Molano, M. A. (1995). Are religion and spirituality clinically relevant in health care?Mind/Body Medicine 1:147–57
Matthews, D. A., Larson, D. B. (1995). The Faith Factor: An Annotated Bibliography of Clinical Research on Spiritual Subjects, Volume 3. Bethesda, MD: National Institute for Healthcare Management
Koenig, H., Idler, E., Kasl, S.et al. (1999). Religion, spirituality, and medicine: a rebuttal to skepticsInternational Journal of Psychiatry in Medicine 29(2):123–31
Pargament, K. A. (1997). The Psychology of Religion and Coping. New York: Guilford Press
Johnston-Taylor, E. (2001). Spiritual Assessment. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 397–406. New York: Oxford University Press
Kemp, C. (2001). Spiritual Care Interventions. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 407–14. New York: Oxford University Press
Wenzl, C. (2001). The role of the nurse chaplain: a personal reflection. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 425–34. New York: Oxford University Press
Borneman, T., Brown-Slatzman, K. (2001). Meaning in illness. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 415–24. New York: Oxford University Press
Lynn, J. (2001). Serving patients who may die soon and their families: The role of hospice and other servicesJournal of the American Medical Association 285(7):925–32
Field, M. J., Cassel, C. K. (Ed.) (1997). Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press
Lynn, J., Teno, J. M., Phillips, R. S.et al. (1997). Perceptions by family members of the dying experience of older and seriously ill patientsAnnals of Internal Medicine 126:97–106
Teno, J. (2000). Toolkit of Instruments to Measure End of Life Care. http://www.chcr.brown.edu/pcoc/. Last accessed on September 11, 2004
Teno, J. (2001). Quality of care and quality indicators for end-of-life cancer care: hope for the best, yet prepare for the worst. In Improving Palliative Care for Cancer: Summary and Recommendations, ed. K. M. Foley and H. Gelband, pp. 3-1–3-49. Washington, DC: National Academy Press
Guo, H., Fine, P. G., Mendoza, T. R., Cleeland, C. S. (2001). A preliminary study of the utility of the brief hospice inventoryJournal of Pain and Symptom Management 22(2):637–48
Aaronson, N. K., Ahmedzai, S., Bergman, B.et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncologyJournal of the National Cancer Institute 85:365–76
Ferrans, C. E., Powers, M. J. (1985). Quality of Life Index: development and psychometric propertiesAdvances in Nursing Science 8:5–24
Finkelstein, D. M., Cassileth, B. R., Bonomi, P. D.et al. (1988). A pilot study of the functional living index-cancer (FLIC) scale for the assessment of quality of life for metastatic lung cancer patientsAmerican Journal of Clinical Oncology 11:630–3
McMillan, S. C. (1996). Quality of life in hospice patientsOncology Nursing Forum 22:1401–9
Cohen, S. R., Mount, B. M., Bruera, E.et al. (1997). Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domainPalliative Medicine 11:3–20
Cohen, S. R., Mount, B. M., Strobel, M. G.et al. (1995). The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptabilityPalliative Medicine 9:207–19
Ware, J. E., Sherbourne, C. D. (1992). The MOS 36-item short form health survey (SF-36): conceptual framework and item selectionMedical Care 30(6):473–83
Byock, I. R. (1995). Missoula-VITAS Quality of Life Index: Version-25S. Missoula, MT: VITAS Healthcare Corporation
Byock, I., Merriman, M. P. (1998). Measuring quality of life for patients with terminal illness: the Missoula VITAS quality of life indexPalliative Medicine 12:231–44
Greer, D. S., Mor, V., Sherwood, S. et al. (1984). National Hospice Study Final Report. Providence, RI: Brown University
Padilla, G. V., Presant, G., Grant, M. M.et al. (1983). Quality of life index for patients with cancerResearch Nursing in Health 6:117–26
Andresen, E. M., Rothenberg, B. M., Kaplan, R. M. (1998). Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adultsMedical Care 36:1349–60
Bergner, M., Bobbitt, R., Carter, W. B., Gilson, B. S. (1981). The Sickness Impact Profile: development and final revision of a health status measureMedical Care 19(8):787–805
Moinpour, C. M., Hutchinson, F., Hayden, K.et al. (1990). Quality of life assessment in Southwest Oncology Group trialsOncology (Huntington) 4:79–93
Spitzer, W. O., Dobson, A. J., Hall, J.et al. (1981). Measuring the quality of life of cancer patients: a concise QL-index for use by physiciansJournal of Chronic Diseases 34:585–97
Erickson, this volume, Chapter 3
Feeny, this volume, Chapter 4
O'Boyle, C. A., Waldron, D. (1997). Quality of life issues in palliative medicineJournal of Neurology 244 (Suppl. 4):S18–25
Portenoy, R. K., Thaler, H. T., Kornblith, A. B.et al. (1994). The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics, and distressEuropean Journal of Cancer 30A:1326–36
Cohen, S. R., Mount, B. M., Tomas, J. N., Mount, L. F. (1996). Existential well-being is an important determinant of quality of life. Evidence from the McGill Quality of Life QuestionnaireCancer 77:576–86
O'Connor, A. P., Wicker, C. A., Germino, B. B. (1990). Understanding the cancer patient's search for meaningCancer Nursing 13:167–75
Reed, P. G. (1987). Spirituality and well being in terminally ill hospitalized adultsResearch Nursing in Health 10:335–44
Yalom, I. D. (1980). Existential Psychotherapy. New York: Basic Books
Tierney, R. M., Horton, S. M., Hannan, T. J., Tierney, W. M. (1998). Relationships between symptom relief, quality of life, and satisfaction with hospice carePalliative Medicine 12:333–44
Bruera, E., Kuehn, N., Miller, M. J.et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patientsJournal of Palliative Care 7:6–9
Ferrell, B. R., Grant, M., Padilla, G., Vemuri, S., Rhiner, M. (1991). The experience of pain and perceptions of quality of life: validation of a conceptual modelThe Hospice Journal 7(3):9–24
Ferrell, B. R., Dow, K. H., Grant, M. (1995). Measurement of the quality of life in cancer survivorsQuality of Life Research 4:523–31
Juarez, G., Ferrell, B. R., Borneman, T. (1998a). Influence of culture on cancer pain management in Hispanic patients (Part I)Cancer Practice 6(Part 5):262
Juarez, G., Ferrell, B. R., Borneman, T. (1998b). Perceptions of quality of life in Hispanic patients (Part II)Cancer Practice 6(Part 6):318
Seidman, A. D., Portenoy, R. K., Yao, T. J.et al. (1995). Quality of life in phase II trials: a study of methodology and predictive value in patients with advanced breast cancer treated with paclitaxel plus granulocyte colony-stimulating factorJournal of the National Cancer Institute 87:1316–22
Ingham, J. M., Seidman, A., Yao, T. -J.et al. (1996). The importance of frequent pain measurement in a cancer clinical trial: a lesson for quality of life assessmentQuality of Life Research 5:503–7
Osoba, D., Zee, B., Pater, J.et al. (1994). Psychometric properties and responsiveness of the EORTC Quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancerQuality of Life Research 3:353–64
Osoba, D., Aaronson, N., Zee, B.et al. (1997). Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. The Study on Quality of Life of the EORTC and the Symptom Control and Quality of Life Committees of the NCI of Canada Clinical Trials GroupQuality of Life Research 6:103–8
Cella, D. F., Tulsky, D. S. (1990). Measuring quality of life today: Methodological aspectsOncology 4(5):29–38
Ferrell, B. R. (1995). The impact of pain on quality of life: a decade of researchNursing Clinics of North America 30(4):609–24
Spilker, B. (1996). Quality of Life and Pharmacoeconomics in Clinical Trials (2nd Edition). New York: Raven Press
Frank-Stromborg, M., Olsen, S. J. (1997). Instruments for Clinical Health-Care Research (2nd Edition). Sudbury, MA: Jones and Bartlett Publishers
Lynn, J., O'Mara, A. (2001). Reliable, high-quality, efficient end-of-life care for cancer patients: economic issues and barriers. In Improving Palliative Care for Cancer: Summary and Recommendations, ed. K. M. Foley, H. Gelband, pp. 2-1–2-45. Washington, DC: National Academy Press
Holland, J. C. (1999). NCCN practice guidelines for the management of psychosocial distressOncology 13(5A):113–47
Cella, D. F., Bonimi, A. E. (1996). The Functional Assessment of Cancer Therapy (FACT) and Functional Assessment of HIV Infection (FAHI) quality of life measurement systems. In Quality of Life and Pharmacoeconomics in Clinical Trials (2nd Edition), ed. B. Spilker, pp. 203–14. New York: Raven Press
Casarett, D., Ferrell, B. R., Kirschling, J.et al. (2001). NHPCO Task Force on Ethics of Hospice Participation in ResearchJournal of Palliative Medicine 4(4):441–9
Baer, W. L., Hanson, J. C. (2000). Families perception of the added value of hospice in the nursing homeJournal of American Geriatric Society 48(8):879–82
McCorkle, R., Robinson, L., Nuameh, I., Lev, E., Benoliel, J. Q. (1998). The effects of home nursing care for patients during terminal illness on the bereaved's psychological distressNursing Research 47(1):2–10
Payne, S., Smith, P., Dean, S. (1999). Identifying the concerns of informal carers in palliative carePalliative Medicine 13(1):37–44
Eich, E., Reeves, J. L., Jaeger, B., Graff-Radford, S. B. (1985). Memory for pain: relation between past and present intensityPain 23:375–9
Eich, E., Reeves, J. L., Katz, R. L. (1985). Anesthesia, amnesia, and the memory/awareness distinctionAnesthesia and Analgesia 64:1143–8
Jamison, R. N., Reeves, J. L., Salovey, P., Pearson, R. (1990). Symposium on pain memory: clinical and cognitive issuesProceedings of the Ninth Annual Meeting of the American Pain Society 1:1
Aucoin-Gallant, G. (1999). Description of caregiver's educational needs and the degree of their dissatisfactionCanadian Oncology Nursing 9(4):165–7, 170–4
Hickman, S. E., Tilden, V. P., Tolle, S. W. (2001). Family reports of dying patients' distress: the adaptation of a research tool to assess global symptom distress in the last week of lifeJournal of Pain and Symptom Management 22(1):565–74
Ferrell, B. R., Grant, M. (2001). Nursing research. In Textbook of Palliative Nursing, ed. B. R. Ferrell, N. Coyle, pp. 701–12. New York: Oxford University Press
American Medical Association (1998). EPEC: Educating Physicians in End of Life Care. Chicago, IL: American Medical Association
Loscalzo, M. (1996). Psychological approaches to the management of pain in patients with advanced cancerHematology/Oncology Clinics of North America 10(1):139–55
Loscalzo, M., Jacobsen, P. B. (1990). Practical behavioral approaches to effective management of pain and distressJournal of Psychosocial Oncology 8(2/3):139–69
Grant, M., Ferrell, B. R., Rivera, L., Lee, J. (1995). Unscheduled readmissions for uncontrolled symptoms: a health care challenge for nursesNursing Clinics of North America 30(4):673–82
Eischens, M. J., Elliott, B. A., Elliott, T. E. (1998). Two hospice quality of life surveys: a comparisonAmerican Journal of Hospice and Palliative Care 15(3):143–8
Chang, V. T., Hwang, S. S., Feuerman, M. (2000). Validation of the Edmonton Symptom Assessment ScaleCancer 88(9):2164–71
Chang, V. T., Hwang, S. S., Feuerman, M., Kasimis, B. S., Thaler, H. T. (2000). The Memorial Symptom Assessment Scale Short Form (MSAS-SF): reliability and validityCancer 89(5):1163–71
Collins, J. J., Devine, T. D., Dick, G. S.et al. (2002). The measurement of symptoms on young children with cancer. The validation of the Memorial Symptom Assessment Scale in children aged 7–12Journal of Pain and Symptom Management 23(1):10–16