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Evaluation

Are you evaluating a cancer patient receiving palliative care?

Select the appropriate answer for each physical symptom

Pain

Feeling weak

Loss of appetite

Dry mouth

Constipation

Diarrhea

Insomnia

Drowsiness

Difficulty breathing

Headache

Tremors

Difficulty swallowing

Nausea

Confusion

Itching

Coughing

Sweating

Vomiting

Dizziness

Hiccups

Global sense of not feeling well

Select the appropriate answer for each psychological symptom

Feeling sad or depressed

Feeling anxious or scared

Feeling nervous, restless or irritable

Feeling insecure

Problems concentrating/paying attention

Difficulty in relaxing

Select the appropriate column for each activity

Difficulty working

Difficulty with leisure time activities

Need help eating

Need help getting dressed

Need help using the toilet

Arguing with family members

Feeling isolated

Results

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