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HCC Questionnaire

HCC Questionnaire

The link you have used to access this questionnaire is incorrect

Thank you for taking the time to complete this questionnaire. Your answers will help your doctor and nurse identify symptoms and concerns prior to your appointment so that problems can be more effectively managed. Below is a list of statements that other people with your illness have said are important. Please select one option per line to indicate your response as it applies to the past 7 days.

UniqueCode I have a lack of energy Not at all A little bit Somewhat Quite a bit Very much I have nausea Not at all A little bit Somewhat Quite a bit Very much Because of my physical condition, I have trouble meeting the needs of my family Not at all A little bit Somewhat Quite a bit Very much I have pain Not at all A little bit Somewhat Quite a bit Very much I am bothered by side effects of treatment Not at all A little bit Somewhat Quite a bit Very much I feel ill Not at all A little bit Somewhat Quite a bit Very much I am forced to spend time in bed Not at all A little bit Somewhat Quite a bit Very much I feel close to my friends Not at all A little bit Somewhat Quite a bit Very much I get emotional support from my family Not at all A little bit Somewhat Quite a bit Very much I get support from my friends Not at all A little bit Somewhat Quite a bit Very much My family has accepted my illness Not at all A little bit Somewhat Quite a bit Very much I am satisfied with family communication about my illness Not at all A little bit Somewhat Quite a bit Very much I feel close to my partner (or the person who is my support) Not at all A little bit Somewhat Quite a bit Very much Regardless of your current level of sexual activity, please answer the following question. If you would prefer not to answer it, please select 'Prefer not to answer' and go to the next question.I am satisfied with my sex life Not at all A little bit Somewhat Quite a bit Very much Prefer not to answer I feel sad Not at all A little bit Somewhat Quite a bit Very much I am satisfied with how I am coping with my illness Not at all A little bit Somewhat Quite a bit Very much I am losing hope in the fight against my illness Not at all A little bit Somewhat Quite a bit Very much I feel nervous Not at all A little bit Somewhat Quite a bit Very much I worry about dying Not at all A little bit Somewhat Quite a bit Very much I worry that my condition will get worse Not at all A little bit Somewhat Quite a bit Very much I am unable to work (include work at home) Not at all A little bit Somewhat Quite a bit Very much My work (including work at home) is fulfilling Not at all A little bit Somewhat Quite a bit Very much I am able to enjoy life Not at all A little bit Somewhat Quite a bit Very much I have accepted my illness Not at all A little bit Somewhat Quite a bit Very much I am sleeping well Not at all A little bit Somewhat Quite a bit Very much I am enjoying the things I usually do for fun Not at all A little bit Somewhat Quite a bit Very much I am content with the quality of my life right now Not at all A little bit Somewhat Quite a bit Very much I have swelling or cramps in my stomach area Not at all A little bit Somewhat Quite a bit Very much I am losing weight Not at all A little bit Somewhat Quite a bit Very much I have control of my bowels Not at all A little bit Somewhat Quite a bit Very much I can digest my food well Not at all A little bit Somewhat Quite a bit Very much I have diarrhoea Not at all A little bit Somewhat Quite a bit Very much I have a good appetite Not at all A little bit Somewhat Quite a bit Very much I am unhappy about the change in my appearance Not at all A little bit Somewhat Quite a bit Very much I have pain in my back Not at all A little bit Somewhat Quite a bit Very much I am bothered by constipation Not at all A little bit Somewhat Quite a bit Very much I feel fatigued Not at all A little bit Somewhat Quite a bit Very much I am unable to do my usual activities Not at all A little bit Somewhat Quite a bit Very much I am bothered by jaundice or yellow colour of my skin Not at all A little bit Somewhat Quite a bit Very much I have had fevers (episodes of high body temperature) Not at all A little bit Somewhat Quite a bit Very much I have had itching Not at all A little bit Somewhat Quite a bit Very much I have had a change in the way food tastes Not at all A little bit Somewhat Quite a bit Very much I have had chills Not at all A little bit Somewhat Quite a bit Very much My mouth is dry Not at all A little bit Somewhat Quite a bit Very much I have discomfort or pain in my stomach area Not at all A little bit Somewhat Quite a bit Very much Have you lost weight recently without trying? No Unsure Yes

How much? (kg) 1-5 6-10 7-11 Greater than 15 Unsure

Have you been eating poorly because of a decreased appetite? No Yes Are you experiencing pain or redness of the hand or foot? No Yes

In what way? Redness without pain Redness, peeling, blisters with pain effecting your ability to use your hands or walk Redness, peeling, blisters with pain effecting your ability to care for yourself

How many hospital admissions have you had since your last clinic appointment? Are you interested in taking part in clinical trials into new treatments for Hepatocellular carcinoma? No Yes

Last Updated: 19/09/2023

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