ICHOM FHIR Implementation Guide: Breast Cancer
0.0.1 - ci-build International flag

ICHOM FHIR Implementation Guide: Breast Cancer, published by ICHOM. This is not an authorized publication; it is the continuous build for version 0.0.1). This version is based on the current content of https://github.com/HL7/fhir-ichom-breast-cancer-ig/ and changes regularly. See the Directory of published versions

Questionnaire: EORTCQLQ (Experimental)

Official URL: https://connect.ichom.org/fhir/Questionnaire/EORTCQLQ Version: 0.0.1
Draft as of 2022-03-28 Computable Name: EORTCQLQ
Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. EORTCQLQQuestionnairehttps://connect.ichom.org/fhir/Questionnaire/EORTCQLQ#0.0.1
... EORTCQLQC30_TimingWhat is the timing of the response of this questionnaire?1..1choiceValue Set: Timing of the response of the patient reported outcome measures
... Group_Q01-Q05We are interested in some things about you and your health. Please answer all of the questions yourself by selecting the answer that best applies to you. There are no 'right' or 'wrong' answers. The information that you provide will remain strictly confidential.0..1group
.... EORTCQLQC30_Q01Do you have any trouble doing strenuous activities, like carrying a heavy shopping bag or a suitcase?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q02Do you have any trouble taking a long walk?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q03Do you have any trouble taking a short walk outside of the house?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q04Do you need to stay in bed or a chair during the day?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q05Do you need help with eating, dressing, washing yourself or using the toilet?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
... Group_Q06-Q28During the past week:0..1group
.... EORTCQLQC30_Q06Were you limited in doing either your work or other daily activities?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q07Were you limited in pursuing your hobbies or other leisure time activities?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q08Were you short of breath?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q09Have you had pain?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q10Did you need to rest?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q11Have you had trouble sleeping?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q12Have you felt weak?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q13Have you lacked appetite?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q14Have you felt nauseated?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q15Have you vomited?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q16Have you been constipated?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q17Have you had diarrhea?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q18Were you tired?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q19Did pain interfere with your daily activities?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q20Have you had difficulty in concentrating on things, like reading a newspaper or watching television?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q21Did you feel tense?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q22Did you worry?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q23Did you feel irritable?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q24Did you feel depressed?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q25Have you had difficulty remembering things?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q26Has your physical condition or medical treatment interfered with your family life?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q27Has your physical condition or medical treatment interfered with your social activities?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQC30_Q28Has your physical condition or medical treatment caused you financial difficulties?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
... Group_Q29-Q30For the following questions please select the number between 1 and 7 that best applies to you, with 1 = Very poor and 7 = Excellent.0..1group
.... EORTCQLQC30_Q29How would you rate your overall health during the past week?1..1choiceOptions: 7 options
.... EORTCQLQC30_Q30How would you rate your overall quality of life during the past week?1..1choiceOptions: 7 options
... Group_Q31-Q43Patients sometimes report that they have the following symptoms or problems. Please indicate the extent to which you have experienced these symptoms or problems during the past week. Please answer by selecting the answer that best applies to you. During the past week:0..1group
.... EORTCQLQBR23_Q31Did you have a dry mouth?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q32Did food and drink taste different than usual?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q33Were your eyes painful, irritated or watery?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q34Have you lost any hair?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q35Were you upset by the loss of your hair?0..1choiceEnable When: EORTCQLQBR23_Q34 = true
Value Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q36Did you feel ill or unwell?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q37Did you have hot flushes?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q38Did you have headaches?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q39Have you felt physically less attractive as a result of your disease or treatment?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q40Have you been feeling less feminine as a result of your disease or treatment?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q41Did you find it difficult to look at yourself naked?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q42Have you been dissatisfied with your body?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q43Were you worried about your health in the future?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
... Group_Q44-Q46During the past four weeks:0..1group
.... EORTCQLQBR23_Q44To what extent were you interested in sex?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q45To what extent were you sexually active? (with or without intercourse)1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q46To what extent was sex enjoyable for you?0..1choiceEnable When: EORTCQLQBR23_Q45 = true
Value Set: Values used in EORTC-QLQ questionnaire response
... Group_Q47-Q53During the past week:0..1group
.... EORTCQLQBR23_Q48Did you have a swollen arm or hand?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q49Was it difficult to raise your arm or to move it sideways?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q50Have you had any pain in the area of your affected breast?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q51Was the area of your affected breast swollen?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q52Was the area of your affected breast oversensitive?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTCQLQBR23_Q53Have you had skin problems on or in the area of your affected breast (e.g., itchy, dry, flaky)?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response
.... EORTC QLQ-LMC21Have you had tingling hands or feet?1..1choiceValue Set: Values used in EORTC-QLQ questionnaire response

doco Documentation for this format

Option Sets

Answer options for EORTCQLQC30_Q29

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Answer options for EORTCQLQC30_Q30

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