Assessment Tools
The following tools can be used for symptom assessment in clinical practice. With increased emphasis on patient and family engagement in care and healthcare decision making, the importance of assessment using patient-reported outcomes (PROs) to achieve high-quality care is well recognized. With a project team of ONS member volunteers, ONS has established criteria for ONS-recommended PRO assessment tools. An initial set of instruments meeting these criteria is available to download. These tools are intended for use in clinical practice and quality-improvement efforts; any use for research purposes requires permission from developers of the instruments.
Assessment tools for the following symptoms can be downloaded and where available are provided in both English and Spanish versions. Instruments in additional languages and availability in different formats can be found at the links for further information provided for each tool.
Patient Reported Outcome Measures
| HealthMeasures is a resource to assist clinicians and researchers to expand and automate several patient-reported outcome measurement systems (PROMIS ®, NIH Toolbox ®, Neuro-QoL™, and ASCQ-Me ®). Their website provides easy searching to find the right tool along with information on application and scoring as well as many additional resources to help you incorporate these measures into your practice and research. |
Multiple Symptom Assessment
MD Anderson Symptom Inventory: English
MD Anderson Symptom Inventory: Spanish
| Description: Measurement of 13 common symptoms for severity and interference with aspects of daily life on 10-point numeric rating scales. Average time to complete: 4.8 minutes. Interpretation: Scores of 5–6 are considered moderate, and scores of 7–10 are considered severe. Minimally important difference or score change ranges 0.98–1.21 (Cleeland, 2016). Additional translations are available. Browse additional information. |
Anxiety
Generalized Anxiety Disorder 7-Item Scale (GAD 7): English
Generalized Anxiety Disorder 7-item Scale (GAD 7): Spanish
| Description: Measurement of seven anxiety symptoms on 4-point scales. Average time to complete: 3 minutes. Interpretation: Total scores of 5, 10, and 15 represent cutpoints for mild, moderate, and severe anxiety. Multiple translations are available. Browse additional information. |
Depression
Patient Health Questionnaire (PHQ9): English
Patient Health Questionnaire (PHQ9): Spanish
| Description: Nine items on 4-point scales and 4-point scale for impact on daily life. Average time to complete: 3.6 minutes. Interpretation: Scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe, and severe depression. Score 5: Repeat at followup and monitor. Score 10–14: Initiate a treatment plan. Score 15–19: Active treatment with psychotherapy or pharmacotherapy. Score 20–27: Immediate pharmacotherapy and specialist referral. (Instruction manual) Multiple translations are available. Browse additional information. |
Fatigue
Brief Fatigue Inventory: English
Brief Fatigue Inventory: Spanish
| Description: Measurement of nine items on 10-point numeric scales for fatigue level and interference with daily life. Average time to complete: 2.67 minutes. Interpretation: Cutpoints for fatigue level suggested are 1–3 (mild), 4–7 (moderate), and 8–10 (severe) (Chang, 2007). Levels of 4 or greater suggest a need for intervention beyond activities for prevention. Browse additional information. |
Pain
Brief Pain Inventory: English
Brief Pain Inventory: Spanish
| Description: Questions for presence of pain; use of pain medication; diagram to identify pain location; four items to rate worst, least, average, and current pain intensity on 10-point numeric scales; questions for relief from treatment for pain and pain description. Average time to complete: 9.8 minutes. Interpretation and scoring: Four items for intensity can be used alone. A two-point difference in intensity rating has been suggested as a MID for this tool (Mathias, 2011). This tool is not suggested for initial pain screening but is seen as useful for more comprehensive follow-up assessment for individuals who report having pain. Browse additional information. |
Sleep
Insomnia Severity Index: English
| Description: Measurement of seven items regarding the insomnia problem, interference with functioning, related distress, and sleep satisfaction. Average time to complete: 3 minutes. Interpretation: Scoring interpretation is shown on the tool. Individuals with moderate (scores 15–21) or severe (scores 22–28) insomnia should be considered for specialized follow up and interventions. A six-point change in score has been suggested as a minimally clinical important difference for the ISI (Yang, 2009). |
ONS Criteria for Assessment Tool Recommendation
Criteria were established by the project team, and selected tools were evaluated according to these criteria.
- Acceptable reliability
- Content validity established by oncology content experts or previous validation or use in patients with cancer
- Practical for clinical application, including brief, ease of use, scoring and interpretation
- Potential for incorporation into electronic health records
- Direct availability via the ONS website
Preferred characteristics include
- Information regarding tool responsiveness to change
- Information regarding clinically important and meaningful difference (that difference that show a meaningful change for improvement or decline)
- Availability in multiple languages.
Benefits of PRO Measurement
- Assessment tools that present measurement of patient-reported outcomes provide a mechanism for clinicians to engage patients and caregivers in care planning.
- These tools can be used to provide more detailed initial level of symptom assessment for individuals who indicate symptom distress in overall distress screening.
- PROs can be used to facilitate objective goal setting with patients to identify desired levels of symptom improvement. Repeated use enables evaluation of effectiveness of interventions provided.
- Numeric results from tools can be incorporated into electronic health records, and some instruments are already designed for electronic use. Incorporation into electronic health records can meet current meaningful use requirements.
For questions about use or interpretation, please contact research@ons.org.
References
Chang, Y.J., Lee, J.S., Lee, C.G., Lee, W.S., Lee, K.S., . . . Yun, Y.H. (2007). Assessment of clinical relevant fatigue level in cancer. Supportive Care in Cancer, 15, 891–896. doi:10.1007/s00520-007-0219-x
Cleeland, C.S. (2016). The M.D. Anderson Symptom Inventory User Guide, Version 1. Houston, TX: University of Texas MD Anderson Cancer Center.
Mathias, S.D., Crosby, R.D., Qian, Y., Jiang, Q., Dansey, R., & Chung, K. (2011). Estimating minimally important differences for the worst pain rating of the Brief Pain Inventory, short form. Journal of Supportive Oncology, 9, 72–78. doi:10.1016/j.suponc.2010.12.004
Yang, M., Morin, CM., Schaefer, K., & Wallenstein, GV. (2009). Interpreting score differences in the insomnia severity index: Using health related outcomes to define the minimally important difference. Current Medical Research and Opinion, 25, 2487–2494. doi:10.1185/03007990903167415
Yost, K.J., Eton, D.T., Garcia, S.F.Y., & Cella, D. (2011). Minimally important differences were estimated for six PROMIS-Cancer scales in advanced stage cancer patients. Journal of Clinical Epidemiology, 54, 507–516. doi:10.1016/jclinepi.2010.11.018