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Section of Supportive Hospice and Palliative MedicineDepartment of Family and Community Medicine

University of the Philippines – Philippine General HospitalManila

SHPM PROGRAM DOCUMENT (CFAT 012011-14)

COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR CLINICAL PRACTICE & RESEARCH

MD ANDERSON SYMPTOM INVENTORY (MDASI)

AUTHOR/S: Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

FILIPINO VERSION: The original English Version was translated and validated in Filipino (Tagalog).

PURPOSE: To assess the severity of multiple symptoms and the impact of symptoms on daily functioning

DESCRIPTION: The MDASI is a brief, simple, and easy to use tool for the assessment of multiple symptoms in both clinical and researchsettings. Symptoms produced by the cancer itself or the disease treatment collectively impose a “symptom burden” upon the patient.Symptom burden is the sum of the severity and impact of symptoms reported by a significant proportion of patients with a given disease ortreatment. The MDASI aims to address the need to assess multiple symptoms simultaneously to determine symptom burden. The originalMDASI (English) has been validated in a sample of cancer patients at M. D. Anderson. In the Philippines, cancer patients and community-dwelling adults participated in a cross-sectional validation study of the Filipino version of the M. D. Anderson Symptom Inventory.

SCORING: In Part 1, the Symptom Scale, (13 items), MDASI assesses a concise set of symptoms that are applicable to most patients withcancer. In Part 2, the Interference Scale, (6 items) it asks patients to rate how severely their symptoms interfere with physical and affectivefunctional domains. The MDASI assesses the severity of symptoms at their worst in the last 24 hours on a 0–10 scale, with 0 being “not

present” and 10 being “as bad as you can imagine.” A Global Symptom Score can be obtained by taking the average of the 13 symptom items(sum of 13 symptoms divided by 13). A prorated Total Score can also be obtained when patients score at least 7 of the 13 items using theformula: (sum of items answered) x 13 / number of items answered. Global and Total Scores can also be obtained for the Interference Scale.

RELIABILITY: In the original MDASI (English) study, 2 factors (2 sets of symptoms: general and gastrointestinal symptoms) weredetermined from the 13 symptom items (Part 1). Cronbach alpha values for the 2 sets of symptoms and the interference scale (Part 2) werecalculated for both the validation and cross-validation samples. The alpha for the two sets of symptoms and the interference scales (Part 2),respectively, were 0.85, 0.82, and 0.91 for the validation sample and 0.87, 0.87 and 0.94 for the cross-validation sample, which shows a highlevel of reliability for these sets of items. In the original Filipino MDASI study, both exploratory factor analysis and hierarchical clusteranalysis also revealed the same two underlying symptom severity constructs consistent with the English version of the MDASI. Cronbachalpha coefficients of 0.79 and 0.77, respectively, demonstrated acceptable internal consistency for the two factors.

VALIDITY: The original MDASI (English) has been used in several validation studies. For the Filipino MDASI, known-group validity wasconfirmed by significant differences on MDASI items by performance status (P