The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 3: Assessment of Physical SymptomsFigure 3-8: Memorial Symptom Assessment Scale - Short Form (MSAS-SF)The Memorial Symptom Assessment Scale Short Form (MSAS-SF) is an abbreviated versionof the Memorial Symptom Assessment Scale which measures each of 32 symptoms with respectto frequency or distress alone. The patient is asked to rate the severity or frequency of26 picaseach symptom himself or herself. This instrument is easy to administer and is reported tousually take less than five minutes to complete. For patients with limited stamina this formmay be an effective instrument for monitoring symptoms in an in- or out-patient setting.I. INSTRUCTIONS: Below is a list of symptoms. If you had the symptom DURING THE PAST WEEK, please check Yes.If you did have the symptom, please check the box that tells us how much the symptom DISTRESSED or BOTHERED you.Check all the symptoms you havehad during the PAST WEEK.Difficulty concentratingPainLack of energyCoughChanges in skinDry mouthNauseaFeeling drowsyNumbness/tingling in hands& feetDifficulty sleepingFeeling bloatedProblems with urinationVomitingShortness of breathDiarrheaSweatsMouth soresProblems with sexual interestor activityItchingLack of appetiteDizzinessDifficulty swallowingChange in the way food tastesWeight lossHair lossConstipationSwelling of arms or legs“I don’t look like myself.”If you had any other symptomsduring the PAST WEEK, pleaselist them below, and indicate howmuch the symptom DISTRESSEDor BOTHERED you.1.2.➨ ➨ IF YES: How much did it DISTRESS or BOTHER you?Yes Not at A little Some- Quite VeryAll Bit what a Bit Much[✓] [0] [1] [2] [3] [4]II. Below are other commonly listed symptoms. Please indicate if you have had the symptom DURING THE PAST WEEK, and ifso, how OFTEN it occurred.Check all the symptoms you havehad during the PAST WEEK.Feeling sadWorryingFeeling irritableFeeling nervous➨ ➨ IF YES: How OFTEN did it occur?YesAlmostRarely Occasionally Frequently Constantly[✓] [1] [2] [3] [4]Source: Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler BT. The Memorial Sympton Assessment Scale - Short Form (MSAS-SF)Cancer 89:1162-71, 2000. Copyright 2000, American Cancer Society. Reproduced with permission of Wiley-Liss, Inc., subsidiary of JohnWiley and Sons, Inc.80U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau