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IPOS Assessment
Integrated Palliative care Outcome Scale
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Q1. What have been your main problems or concerns over the past 3 days?
0/100
Q2. Below is a list of symptoms, which you may or may not have experienced. For each symptom, please tick one box that best describes how it has affected you over the past 3 days.
Pain
0
Not at all
1
2
3
4
Over- whelm.
Shortness of Breath
0
Not at all
1
2
3
4
Over- whelm.
Weakness
0
Not at all
1
2
3
4
Over- whelm.
Nausea
0
Not at all
1
2
3
4
Over- whelm.
Vomiting
0
Not at all
1
2
3
4
Over- whelm.
Poor Appetite
0
Not at all
1
2
3
4
Over- whelm.
Constipation
0
Not at all
1
2
3
4
Over- whelm.
Sore/Dry Mouth
0
Not at all
1
2
3
4
Over- whelm.
Drowsiness
0
Not at all
1
2
3
4
Over- whelm.
Poor Mobility
0
Not at all
1
2
3
4
Over- whelm.
Please list any other symptoms not mentioned above, and tick one box to show how they have affected you over the past 3 days.
0
Not at all
1
2
3
4
Over- whelm.
0
Not at all
1
2
3
4
Over- whelm.
0
Not at all
1
2
3
4
Over- whelm.
Q3. Have you been feeling anxious or worried about your illness or treatment?
0
Not at all
1
2
3
4
Always
Q4. Have any of your family or friends been anxious or worried about you?
0
Not at all
1
2
3
4
Always
Q5. Have you been feeling depressed?
0
Not at all
1
2
3
4
Always
Q6. Have you felt at peace?
0
Always
1
2
3
4
Not at all
Q7. Have you been able to share how you are feeling with your family or friends as much as you wanted?
0
Always
1
2
3
4
Not at all
Q8. Have you had as much information as you wanted?
0
Always
1
2
3
4
Not at all
Q9. Have any practical problems resulting from your illness been addressed? (such as financial or personal)
0
Addressed
1
2
3
4
Not addressed
Q10. How did you complete this questionnaire?
On my own
With help from a friend or relative
With help from a member of staff
Total IPOS Score
Higher = More Distress
0
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