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Dear Canine Cancer Patient Owner/Guardian, We really appreciate that you are taking time to complete the questionnaire about your dogs well-being and health related quality of life. This will help us assess your dogs quality of life. All your answers will be treated with the strictest confidence. Please observe the Instructions below: Only one owner, the person with whom the dog relates mostly should answer the questions and they should do so on their own. Read each question carefully, if you do not know the answer, please indicate so, by writing: Don't know. 1. Have you had your dog since he/she was a puppy? Yes __ No__ 2. If not, how many years ago did you adopt it? ____ A. INFORMATION ABOUT YOUR DOG'S QUALITY OF LIFE ABOUT YOUR DOG NOW: 1. How much is your dog bothered by the cancer? a. Not at all, b. Somewhat, c. Moderately, d. A lot, e. Extremely 2. Does your dog still enjoy his favorite activity? a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 3. Did you notice any changes in your dog's sleeping/resting patterns? a. None, b. Minimal, c. Moderate, d. A lot, E. Extreme 4. Your dog's behavior towards you is: a. Friendly, easily excited, b. Friendly, alert c. Mostly friendly, appropriate, d. Passive, indifferent, e. Aggressive 5. Your dog's appetite now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 6. Your dog's quality of life now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 7. Your dog's playfulness and activity level now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor
B. INFORMATION ABOUT YOU DURING THAT STRESSFUL PERIOD OF YOUR LIFE ABOUT YOURSELF NOW: 1. How worried are you about your dog's illness? a. Not at all, b. Somewhat, c. Moderately, d. A lot, e. Extremely 2. Rate the amount of worry each of these are causing you: Potential Factors Not at all 1. The chemotherapys administration and side effects (weakness, anorexia, nausea, vomiting) 2. Your pets QOL 3.Urinating/defecating/vomiting Somewhat Moderately A lot Extremely
D. EVALUATION OF OUR SURVEY: 1. How easy was for you to complete the questionnaire? a. Extremely easy, b. Very easy, c. Moderately easy, d. Somewhat easy, e. Not at all 2. Did you like this opportunity to do this survey in order to evaluate your dog's situation? a. Very much, b. Quite a bit, c. Moderately, d. Somewhat, e. Not at all 3. Please comment on how this survey can be improved: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
This is the end of the survey. Thank you for completing the QOL questionnaire!