PRINT FOR REVIEW ONLYMissoula-Vitas Quality of Life Index (tm) INSTRUCTIONS: |
| O | O | O | O | O |
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| O | O | O | O | O |
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| O | O | O | O | O |
3. I accept my symptoms as a fact of life. |
| O | O | O | O | O |
4. I am satisfied with current control of my symptoms. |
| O | O | O | O | O |
| 5. | Despite physical discomfort, in general I can enjoy my days. | OR | Physical discomfort overshadows and opportunity for enjoyment. |
| O | O | O | O | O |
| FUNCTION |
| 6. | I am still able to attend to most of my personal needs by myself. | OR | I am dependant on others for my personal care. |
| O | O | O | O | O |
| 7. | I am still able to do many of the things I like to do. | OR | I am no longer able to do many of the things I like to do. |
| O | O | O | O | O |
| 8. I am satisfied with my ability to take care of my basic needs. |
| O | O | O | O | O |
| 9. | I accept the fact that I can not do many of the things I used to do. | OR | I am disappointed that I can not do many of the things I used to do. |
| O | O | O | O | O |
10. My contentment with life depends upon being active and being independent in my personal care. |
| | | | O | O |
| INTERPERSONAL 11. I have recently been able to say important things to the people close to me. |
| | | O | O | O |
| 12. | I feel closer to others in my life now than I did before my illness. | OR | I feel increasingly distant from others in my life. |
| | O | | O | O |
| 13. In general, these days I am satisfied with relationships with family and friends. |
| O | O | O | O | O |
| 14. At present, I spend as much time as I want to with family and friends. |
| O | O | O | O | O |
| 15. It is important to me to have close personal relationships. |
| O | O | O | O | O |
| WELL BEING |
| 16. | My affairs are in order; I could die today with a clear mind. | OR | My affairs are not in order; I am worried that many things are unresolved. |
| O | O | O | O | O |
| 17. | I feel generally at peace and prepared to leave this life. | OR | I am unsettled and unprepared to leave this life. |
| O | O | O | O | O |
| 18. I am more satisfied with myself as a person now than I was before my illness. |
| O | O | O | O | O |
| 19. | The longer I am ill, the more I worry about things "getting out of control". | OR | The longer I am ill, the more comfortable I am with the idea of "letting go". |
| O | O | O | O | O |
| 20. It is important to me to be at peace with myself. |
| O | O | O | O | O |
| TRANSCENDENT |
| 21. | I have a greater sense of connection to all things now than I did before my illness. | OR | I feel more disconnected from all things now than I did before my illness. |
| O | O | O | O | O |
| 22. | I have a better sense of meaning in my life now than I have had in the past. | OR | I have less of a sense of meaning in my life now than I have had in the past. |
| O | O | O | O | O |
| 23. | As the end of my life approaches, I am comfortable with the thought of my own death. | OR | As the end of my life approaches, I am uneasy with the thought of my own death. |
| O | O | O | O | O |
| 24. | Life has become more precious to me; every day is a gift. | OR | Life has lost all value for me; every day is a burden. |
| O | O | O | O | O |
| 25. It is important to me to feel that my life has meaning. |
| O | O | O | O | O |
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