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Purpose
The MD Anderson Symptom Inventory (MDASI) is a survey that patients will complete at time of tumor imaging to assess the severity of their brain tumor-related symptoms or spinal tumor and the impact these symptoms have on their daily functioning. The MDASI-Simplified form is completed to indicate if MDASI- BT or MDASI-SP forms were completed; to capture the reason if the forms were not completed; Which MDASI Instrument was completed; Date of the completion of the form and who filled the survey.
MDASI-Simplified eCRF
Field Name | Description / Instructions | Format |
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Visit Date(m) | Enter the date the eCRF was completed | DD-MMM-YYYY |
Was MDASI instrument completed? | Indicate whether the MDASI instrument completed: | Use pick list. |
If no, why was the MDASI instrument not completed? | Indicate the reason why the MD Anderson Symptom Inventory was not completed: | Use pick list. |
Which MDASI instrument did the patient complete? | Indicate the text term that represents the name of the MD Anderson Symptom Inventory instrument completed by the patient: MDASI-BT - MD Anderson Symptom Inventory - Brain Tumor MDASI-SP - MD Anderson Symptom Inventory - Spine Tumor | Use pick list. |
Date completed by patient? | Enter the date the MDASI instrument was completed by the patient | DD-MMM-YYYY |
Who filled out the survey? | Optional field. If this information is known, indicate the text term that describes the person who filled out the MD Anderson Symptom Inventory instrument: PATIENT - INDEPENDENTLY - Patient Completed Independently PATIENT WITH CAREGIVER ASSISTANCE TO ENTER DATA - Patient With Caregiver Assistance | Use pick list. |
Legend: (m) RDC mandatory
Validations
Code | Description | Resolutions |
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