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Title

Functional Assessment of Cancer Therapy-Hepatobiliary General Version 4 (FACT-HEP G V4)

CDISC ReferenceQuestionnaire Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

FACT-HEP G V4

QRS Permission StatusApproveApproved
TeamPancreatic Cancer Standards Team and CDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date20022023-1107-1628
Notes
  • This supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.

...

Revision History

DateVersion
20222023-1107-16281.0 Draft

© 2022 Clinical 2023 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

1 Introduction

This document describes the CDISC implementation of the Functional Assessment of Cancer Therapy-Hepatobiliary instrument-General Version 4 (FACT-G V4)

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 instrument.

CDISC did not modify this questionnaires, ratings, and scales (QRS) instrument to meet Clinical Data Acquisition Standards Harmonization (CDASH) case report form (CRF) standards.

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The CDISC Intellectual Property Policy can be found on the CDISC website at: https://www.cdisc.org/about/bylaws.

1.1 Representations and Warranties, Limitations of Liability, and Disclaimers

This document is a supplement to the SDTMIG for Human Clinical Trials and is covered under Appendix F of that document, which describes representations, warranties, limitations of liability, and disclaimers. Please see Appendix F of the SDTMIG for a complete version of this material.

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Although the United States Food and Drug Administration (US FDA) has provided input with regard to this supplement, this input does not constitute US FDA endorsement of any particular instrument.  

2 Copyright Status

David Cella, PhD, owns the copyright for the FACT-HEP G V4 instrument and has granted CDISC permission to include this supplement in the CDISC inventory of QRS data standards supplements. Hence, CDISC developed QSTESTCD and QSTEST for each item based on the actual text on the instrument.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with examples, and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

Info
titleInformation for Reviewers

The CRF is attached at the top of the Wiki. When you click the paperclip image, you will find the file for the annotated CRF.

Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at: https://www.cdisc.org/standards/terminology/controlled-terminology.

CDISC has developed this documentation at no cost to the copyright holder or any additional cost to users of the instrument beyond the normal license fees charged by the copyright holder.

CDISC acknowledges Dr. David Cella and FACIT.org, for the approval to include the FACT-HEP V4 in the CDISC data standards.

Reference for the FACT-HEP V4:

  • Copyright 1987, 1997 David Cella, Ph.D.
  • These materials discuss and/or include FACIT Measurement System, which is owned exclusively by Dr. David Cella. No part of the FACIT Measurement System may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of Dr. David Cella and payment of any applicable fees. Copyright Dr. David Cella. All rights reserved.

3 The QS Domain Model

3.1 Assumptions for the QS Domain Model

These materials discuss and/or include the FACIT Measurement System, which is owned exclusively by Dr. David Cella. No part of the FACIT Measurement System may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of Dr. David Cella and payment of any applicable fees. Copyright Dr. David Cella. All rights reserved. Copyright 1987, 1997 David Cella, PhD.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with examples, and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

Info
titleInformation for Reviewers

The CRF is attached at the top of the Wiki. When you click the paperclip image, you will find the file for the annotated CRF.

Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at: https://www.cdisc.org/standards/terminology/controlled-terminology.

CDISC has developed this documentation at no cost to the copyright holder or any additional cost to users of the instrument beyond the normal license fees charged by the copyright holder.

CDISC acknowledges Dr. David Cella and FACIT.org, for the approval to include the FACT-G V4 in the CDISC data standards.

Reference for the FACT-G V4:

  • FACIT.org for more information as well as the scoring guide.

3 The QS Domain Model

3.1 Assumptions for the QS Domain Model

All assumptions and business rules described in the SDTMIG QS All assumptions and business rules described in the SDTMIG QS domain are applicable to this supplement. Additional assumptions specific to the FACT-HEP G V4 are listed below.

The FACT-HEP G V4 is a multiple-choice health-related general quality of life questionnaire about problems associated with hepatobiliary cancer. It consists of 45 27 items rated on a 5-point scale.

  1. All items rated on a 5-point scale include a numeric rating (0-4) and a definition of what is represented by the rating (e.g., 0 = "Not at all", 4 = "Very much"). For the FACT-HEP G V4, QSORRES is populated with the text description; the numeric rating is represented in the standardized character and numeric result variables QSSTRESC and QSSTRESN.

    1. FAC01514 FAC00114 may be rated on a 5-point scale or the subject may prefer not to answer. When the checkbox is marked that the subject prefers not to rate answer the item, this is noted with QSSTAT = "NOT DONE" and QSREASND = "PREFER NOT TO ANSWER". QSORRES, QSSTRESC, and QSSTRESN are all missing.

  2. The time period of evaluation for the FACT-HEP G V4 is populated in the QSEVLINT field in ISO 8601 format when the evaluation interval can be precisely described as duration. The evaluation interval for the FACT-HEP G V4 is the past 7 days (QSEVLINT = "-P7D").

  3. Items are divided into 5 subcategories represented 4 subcategories

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    represented in QSSCAT: "PHYSICAL WELL-BEING", "SOCIAL/FAMILY WELL-BEING", "EMOTIONAL WELL-BEING", and "FUNCTIONAL WELL-BEING", and "ADDITIONAL CONCERNS".

  4. Records are created in qs.xpt for every item on the instrument

    1. For items with no data, QSORRES, QSSTRESC, and QSSTRESN are all missing and QSSTAT = "NOT DONE".  If the reason is known then that reason is represented in QSREASND (e.g., QSREASND = "LOGICALLY SKIPPED ITEM" or QSREASND = "PREFER NOT TO ANSWER"). If the reason is unknown, then QSSTAT = "NOT DONE" and QSREASND is missing.

  5. The FACT-HEP G V4 instrument includes subscale scores for each subcategory in addition to trial outcome index, FACT-G, and total scores a total score per FACIT.org's scoring materials and are considered as captured data on the CRF and are not considered as derived in the example below. These scores may be submitted in SDTM or derived in the Analysis Data Model (ADaM) per scoring instructions from FACIT.org.

    1. Subscores and total scores are represented in QSORRES.

    2. If scores are received or derived by the sponsor, it is recommended that they are submitted to SDTM and verified in ADaM whenever feasible.
  6. Terminology
    1. QSCAT, QSTESTCD, and QSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the result field is provided in Section 4, SDTM Mapping Strategy.

3.2 Example for the QRS FACT-HEP V4 QS Domain Model

The FACT-HEP V4 example below shows the terminology used to implement the instrument in the QS domain. This example shows the data for 1 subject collected at the baseline visit for the FACT-HEP V4 instrument. The example uses CDISC Controlled Terminology for QSTESTCD, QSTEST, and QSCATAll original results, matching the CRF item response text, are represented in QSORRES. This result is then represented as a standard numeric score in QSSTRESN and as a standard character representation in QSSTRESC.

Info

We are unable to make the example consistently show blue in the Wiki. All examples are updated for each QRS instrument so we ask that you please review the example below.

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    1. that they are submitted to SDTM and verified in ADaM whenever feasible.
  1. Terminology
    1. QSCAT, QSTESTCD, and QSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the result field is provided in Section 4, SDTM Mapping Strategy.

3.2 Example for the QRS FACT-G V4 QS Domain Model

The FACT-G V4 example below shows the terminology used to implement the instrument in the QS domain. This example shows the data for 1 subject collected at the baseline visit for the FACT-G V4 instrument. The example uses CDISC Controlled Terminology for QSTESTCD, QSTEST, and QSCATAll original results, matching the CRF item response text, are represented in QSORRES. This result is then represented as a standard numeric score in QSSTRESN and as a standard character representation in QSSTRESC.


Info

We are unable to make the example consistently show blue in the Wiki. All examples are updated for each QRS instrument so we ask that you please review the example below.


The following table

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represents the items from the FACT-G V4 instrument. The subject was not evaluated on this instrument at visit 2. Since the visit was missed, the reason for not completing the visit was not collected, and no date is assumed for when the visit would have occurred.

Dataset wrap
Nameqs
Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSSCATQSORRESQSSTRESCQSSTRESNQSSTATQSREASNDQSLOBXFLVISITNUMQSDTCQSEVLINT
1
Dataset wrap
Nameqs
Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSSCATQSORRESQSSTRESCQSSTRESNQSSTATQSREASNDQSLOBXFLVISITNUMQSDTCQSEVLINT
1STUDYXQS2324-P00011FAC01501FAC015-I Have a Lack of EnergyFACT-HEP V4PHYSICAL WELL-BEINGA little bit11Y12015-05-15-P7D2STUDYXQS2324-P00012FAC01502FAC015-I Have NauseaFACT-HEP V4PHYSICAL WELL-BEINGNot at all00Y12015-05-15-P7D3STUDYXQS2324-P00013FAC01503FAC015-Trouble Meeting Needs of FamilyFACT-HEP V4PHYSICAL WELL-BEINGSomewhat22Y12015-05-15-P7D4STUDYXQS2324-P00014FAC01504FAC015-I Have PainFACT-HEP V4PHYSICAL WELL-BEINGA little bit11Y12015-05-15-P7D5STUDYXQS2324-P00015FAC01505FAC015-Botheredby Treatment Side EffectFACT-HEP V4PHYSICAL WELL-BEINGNot at all00Y12015-05-15-P7D6STUDYXQS2324-P00016FAC01506FAC015-I Feel IllFACT-HEP V4PHYSICAL WELL-BEINGA little bit11Y12015-05-15-P7D7STUDYXQS2324-P00017FAC01507FAC015-I Am Forced to Spend Time in BedFACT-HEP V4PHYSICAL WELL-BEINGA little bit11Y12015-05-15-P7D8STUDYXQS2324-P00018FAC01508FAC015-I Feel Close to My FriendsFACT-HEP V4SOCIAL/FAMILY WELL-BEINGQuite a bit33Y12015-05-15-P7D9STUDYXQS2324-P00019FAC01509FAC015-Get Emotional Support From FamilyFACT-HEP V4SOCIAL/FAMILY WELL-BEINGQuite a bit33Y12015-05-15-P7D10STUDYXQS2324-P000110FAC01510FAC015-I Get Support From FriendsFACT-HEP V4SOCIAL/FAMILY WELL-BEINGSomewhat22Y12015-05-15-P7D11STUDYXQS2324-P000111FAC01511FAC015-My Family Has Accepted My IllnessFACT-HEP V4SOCIAL/FAMILY WELL-BEINGQuite a bit33Y12015-05-15-P7D12STUDYXQS2324-P000112FAC01512FAC015-Satisfied Communication IllnessFACT-HEP V4SOCIAL/FAMILY WELL-BEINGVery much44Y12015-05-15-P7D13STUDYXQS2324-P000113FAC01513FAC015-I Feel close to My PartnerFACT-HEP V4SOCIAL/FAMILY WELL-BEINGVery much44Y12015-05-15-P7D14STUDYXQS2324-P000114FAC01514FAC015-I Am Satisfied With My Sex LifeFACT-HEP V4SOCIAL/FAMILY WELL-BEINGNOT DONEPREFER NOT TO ANSWERY12015-05-15-P7D15STUDYXQS2324-P000115FAC01515FAC015-I Feel SadFACT-HEP V4EMOTIONAL WELL-BEINGA little bit11Y12015-05-15-P7D16STUDYXQS2324-P000116FAC01516FAC015-Satisfied With How I Am CopingFACT-HEP V4EMOTIONAL WELL-BEINGQuite a bit33Y12015-05-15-P7D17STUDYXQS2324-P000117FAC01517FAC015-Losing Hope Against IllnessFACT-HEP V4EMOTIONAL WELL-BEINGA little bit11Y12015-05-15-P7D18STUDYXQS2324-P000118FAC01518FAC015-I Feel NervousFACT-HEP V4EMOTIONAL WELL-BEINGA little bit11Y12015-05-15-P7D19STUDYXQS2324-P000119FAC01519FAC015-I Worry About DyingFACT-HEP V4EMOTIONAL WELL-BEINGA little bit11Y12015-05-15-P7D20STUDYXQS2324-P000120FAC01520FAC015-Worry My Condition Will Get WorseFACT-HEP V4EMOTIONAL WELL-BEINGSomewhat22Y12015-05-15-P7D21STUDYXQS2324-P000121FAC01521FAC015-I Am Able to WorkFACT-HEP V4FUNCTIONAL WELL-BEINGA little bit11Y12015-05-15-P7D22STUDYXQS2324-P000122FAC01522FAC015-My Work Is FulfillingFACT-HEP V4FUNCTIONAL WELL-BEINGQuite a bit33Y12015-05-15-P7D23STUDYXQS2324-P000123FAC01523FAC015-I Am Able to Enjoy LifeFACT-HEP V4FUNCTIONAL WELL-BEINGQuite a bit33Y12015-05-15-P7D24STUDYXQS2324-P000124FAC01524FAC015-I Have Accepted My IllnessFACT-HEP V4FUNCTIONAL WELL-BEINGSomewhat22Y12015-05-15-P7D25STUDYXQS2324-P000125FAC01525FAC015-I Am Sleeping WellFACT-HEP V4FUNCTIONAL WELL-BEINGSomewhat22Y12015-05-15-P7D26STUDYXQS2324-P000126FAC01526FAC015-Enjoy Things I Usually Do for FunFACT-HEP V4FUNCTIONAL WELL-BEINGSomewhat22Y12015-05-15-P7D27STUDYXQS2324-P000127FAC01527FAC015-Content With Quality of My LifeFACT-HEP V4FUNCTIONAL WELL-BEINGQuite a bit33Y12015-05-15-P7D28STUDYXQS2324-P000128FAC01528FAC015-Swelling/Cramps in Stomach AreaFACT-HEP V4ADDITIONAL CONCERNSSomewhat22Y12015-05-15-P7D29STUDYXQS2324-P000129FAC01529FAC015-I Am Losing WeightFACT-HEP V4ADDITIONAL CONCERNSNot at all00Y12015-05-15-P7D30STUDYXQS2324-P000130FAC01530FAC015-I Have Control of My BowelsFACT-HEP V4ADDITIONAL CONCERNSQuite a bit33Y12015-05-15-P7D31STUDYXQS2324-P000131FAC01531FAC015-I Can Digest My Food WellFACT-HEP V4ADDITIONAL CONCERNSQuite a bit33Y12015-05-15-P7D32STUDYXQS2324-P000132FAC01532FAC015-I Have DiarrheaFACT-HEP V4ADDITIONAL CONCERNSA little bit11Y12015-05-15-P7D33STUDYXQS2324-P000133FAC01533FAC015-I Have a Good AppetiteFACT-HEP V4ADDITIONAL CONCERNSQuite a bit33Y12015-05-15-P7D34STUDYXQS2324-P000134FAC01534FAC015-Unhappy About Change in My AppearFACT-HEP V4ADDITIONAL CONCERNSNot at all00Y12015-05-15-P7D35STUDYXQS2324-P0001351FAC01535FAC00101FAC015FAC001-I Have Pain in My Backa Lack of EnergyFACT-HEP G V4ADDITIONAL CONCERNSPHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
362STUDYXQS2324-P0001362FAC01536FAC00102FAC015FAC001-I Am Bothered by ConstipationHave NauseaFACT-HEP G V4ADDITIONAL CONCERNSA little bit1PHYSICAL WELL-BEINGNot at all001

Y12015-05-15-P7D
373STUDYXQS2324-P0001373FAC01537FAC00103FAC015-I Feel FatiguedFAC001-Trouble Meeting Needs of FamilyFACT-HEP G V4ADDITIONAL CONCERNSPHYSICAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
384STUDYXQS2324-P0001384FAC01538FAC00104FAC015-Able to Do My Usual ActivitiesFAC001-I Have PainFACT-HEP G V4ADDITIONAL CONCERNSPHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
395STUDYXQS2324-P0001395FAC01539FAC00105FAC015-Bothered by Jaundice/Yellow SkinFAC001-Botheredby Treatment Side EffectFACT-HEP G V4ADDITIONAL CONCERNSA little bit1PHYSICAL WELL-BEINGNot at all001

Y12015-05-15-P7D
406STUDYXQS2324-P0001406FAC01540FAC00106FAC015FAC001-I Have Had FeversFeel IllFACT-HEP G V4ADDITIONAL CONCERNSNot at all0PHYSICAL WELL-BEINGA little bit110

Y12015-05-15-P7D
417STUDYXQS2324-P0001417FAC01541FAC00107FAC015FAC001-I Have Had ItchingAm Forced to Spend Time in BedFACT-HEP G V4ADDITIONAL CONCERNSPHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
428STUDYXQS2324-P0001428FAC01542FAC00108FAC015-Had Change in the Way Food TastesFAC001-I Feel Close to My FriendsFACT-HEP G V4ADDITIONAL CONCERNSNot at all0SOCIAL/FAMILY WELL-BEINGQuite a bit330

Y12015-05-15-P7D
439STUDYXQS2324-P0001439FAC01543FAC00109FAC015-I Have Had ChillsFAC001-Get Emotional Support From FamilyFACT-HEP G V4ADDITIONAL CONCERNSNot at all0SOCIAL/FAMILY WELL-BEINGQuite a bit330

Y12015-05-15-P7D
4410STUDYXQS2324-P00014410FAC01544FAC00110FAC015-My Mouth Is DryFAC001-I Get Support From FriendsFACT-HEP G V4ADDITIONAL CONCERNSA little bit1SOCIAL/FAMILY WELL-BEINGSomewhat221

Y12015-05-15-P7D
4511STUDYXQS2324-P00014511FAC01545FAC00111FAC015-Discomfort/Pain in Stomach AreaFAC001-My Family Has Accepted My IllnessFACT-HEP G V4ADDITIONAL CONCERNSSomewhat2SOCIAL/FAMILY WELL-BEINGQuite a bit332

Y12015-05-15-P7D
4612STUDYXQS2324-P00014612FAC01546FAC00112FAC015-Physical Subscale ScoreFAC001-Satisfied Communication IllnessFACT-HEP G V42222SOCIAL/FAMILY WELL-BEINGVery much4422

Y12015-05-15-P7D
4713STUDYXQS2324-P00014713FAC01547FAC00113FAC015-Social/Family Subscale ScoreFAC001-I Feel close to My PartnerFACT-HEP V42222G V4SOCIAL/FAMILY WELL-BEINGVery much4422

Y12015-05-15-P7D
4814STUDYXQS2324-P00014814FAC01548FAC00114FAC015-Emotional Subscale ScoreFAC001-I Am Satisfied With My Sex LifeFACT-HEP G V41717SOCIAL/FAMILY WELL-BEING


NOT DONEPREFER NOT TO ANSWER17Y
12015-05-15-P7D49STUDYXQS2324-P000149FAC01549FAC015-Functional Subscale ScoreFACT-HEP V4161616Y
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12015-05-15-P7D
5015STUDYXQS2324-P00015015FAC01550FAC00115FAC015-Additional Concern Subscale ScoreFAC001-I Feel SadFACT-HEP G V45454EMOTIONAL WELL-BEINGA little bit1154

Y12015-05-15-P7D
5116STUDYXQS2324-P00015116FAC01551FAC00116FAC015-Trial Outcome Index ScoreFAC001-Satisfied With How I Am CopingFACT-HEP G V49292EMOTIONAL WELL-BEINGQuite a bit3392

Y12015-05-15-P7D
5217STUDYXQS2324-P00015217FAC01552FAC00117FAC015FAC001-Losing Hope Against IllnessFACT-G Total ScoreV4FACTEMOTIONAL WELL-HEP V47777BEINGA little bit1177

Y12015-05-15-P7D
5318STUDYXQS2324-P00015318FAC01553FAC00118FAC015-Total ScoreFAC001-I Feel NervousFACT-HEP G V4131131EMOTIONAL WELL-BEINGA little bit11131

Y12015-05-15-P7D
5419STUDYXQS2324-P0001119FAC01501FAC00119FAC015FAC001-I Have a Lack of EnergyWorry About DyingFACT-HEP G V4PHYSICAL EMOTIONAL WELL-BEINGNOT DONE2A little bit11

Y12015-05-15-P7D
2055STUDYXQS2324-P0001220FAC01502FAC00120FAC015-I Have NauseaFAC001-Worry My Condition Will Get WorseFACT-HEP G V4PHYSICAL EMOTIONAL WELL-BEINGNOT DONESomewhat2562

STUDYXYQS12324-P00013FAC01503FAC015-Trouble Meeting Needs of FamilyFACT-HEP V4PHYSICAL WELL-BEINGNOT DONE22015-05-15-P7D
2157STUDYXQS2324-P0001421FAC01504FAC00121FAC015FAC001-I Have PainAm Able to WorkFACT-HEP G V4PHYSICAL FUNCTIONAL WELL-BEINGNOT DONE258STUDYXQS2324-P00015FAC01505FAC015-Botheredby Treatment Side EffectFACT-HEP V4PHYSICAL WELL-BEINGNOT DONE259A little bit11

Y12015-05-15-P7D
22STUDYXQS2324-P0001622FAC01506FAC00122FAC015-I Feel IllFAC001-My Work Is FulfillingFACT-HEP G V4PHYSICAL FUNCTIONAL WELL-BEINGNOT DONE2Quite a bit33

Y12015-05-15-P7D
2360STUDYXQS2324-P0001723FAC01507FAC00123FAC015FAC001-I Am Forced to Spend Time in BedAble to Enjoy LifeFACT-HEP V4PHYSICAL WELL-BEINGNOT DONE2G V4FUNCTIONAL WELL-BEINGQuite a bit33

Y12015-05-15-P7D
2461STUDYXQS2324-P0001824FAC01508FAC00124FAC015FAC001-I Feel Close to My FriendsHave Accepted My IllnessFACT-HEP G V4SOCIAL/FAMILY FUNCTIONAL WELL-BEINGNOT DONESomewhat2622

STUDYXYQS12324-P00019FAC01509FAC015-Get Emotional Support From FamilyFACT-HEP V4SOCIAL/FAMILY WELL-BEINGNOT DONE22015-05-15-P7D
2563STUDYXQS2324-P00011025FAC01510FAC00125FAC015FAC001-I Get Support From FriendsAm Sleeping WellFACT-HEP G V4SOCIAL/FAMILY FUNCTIONAL WELL-BEINGNOT DONESomewhat2642

STUDYXYQS12324-P000111FAC01511FAC015-My Family Has Accepted My IllnessFACT-HEP V4SOCIAL/FAMILY WELL-BEINGNOT DONE2652015-05-15-P7D
26STUDYXQS2324-P00011226FAC01512FAC00126FAC015-Satisfied Communication IllnessFAC001-Enjoy Things I Usually Do for FunFACT-HEP G V4SOCIAL/FAMILY FUNCTIONAL WELL-BEINGSomewhat2NOT DONE2

Y12015-05-15-P7D
2766STUDYXQS2324-P00011327FAC01513FAC00127FAC015-I Feel close to My PartnerFAC001-Content With Quality of My LifeFACT-HEP G V4SOCIAL/FAMILY FUNCTIONAL WELL-BEINGNOT DONE2Quite a bit33

Y12015-05-15-P7D
2867STUDYXQS2324-P00011428FAC01514FAC00128FAC015-I Am Satisfied With My Sex LifeFAC001-Physical Subscale ScoreFACT-HEP V4SOCIAL/FAMILY WELL-BEINGNOT DONE268G V4
222222

Y12015-05-15-P7D
29STUDYXQS2324-P00011529FAC01515FAC00129FAC015-I Feel SadFAC001-Social/Family Subscale ScoreFACT-HEP V4EMOTIONAL WELL-BEINGNOT DONE269G V4
222222

Y12015-05-15-P7D
30STUDYXQS2324-P00011630FAC01516FAC00130FAC015-Satisfied With How I Am CopingFAC001-Emotional Subscale ScoreFACT-HEP G V4EMOTIONAL WELL-BEINGNOT DONE270STUDYXQS2324-P000117FAC01517FAC015-Losing Hope Against IllnessFACT-HEP V4EMOTIONAL WELL-BEINGNOT DONE2
171717

Y12015-05-15-P7D
3171STUDYXQS2324-P00011831FAC01518FAC00131FAC015-I Feel NervousFAC001-Functional Subscale ScoreFACT-HEP G V4EMOTIONAL WELL-BEINGNOT DONE272STUDYXQS2324-P000119FAC01519FAC015-I Worry About DyingFACT-HEP V4EMOTIONAL WELL-BEINGNOT DONE273
161616

Y12015-05-15-P7D
32STUDYXQS2324-P00012032FAC01520FAC00132FAC015-Worry My Condition Will Get WorseFAC001-Total ScoreFACT-HEP G V4EMOTIONAL WELL-BEINGNOT DONE2
777777

Y12015-05-15-P7D
3374STUDYXQS2324-P00012133FAC01521FAC00101FAC015FAC001-I Am Able to WorkHave a Lack of EnergyFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

7534STUDYXQS2324-P00012234FAC01522FAC00102FAC015-My Work Is FulfillingFAC001-I Have NauseaFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

7635STUDYXQS2324-P00012335FAC01523FAC00103FAC015-I Am Able to Enjoy LifeFAC001-Trouble Meeting Needs of FamilyFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

7736STUDYXQS2324-P00012436FAC01524FAC00104FAC015FAC001-I Have Accepted My IllnessPainFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

7837STUDYXQS2324-P00012537FAC01525FAC00105FAC015-I Am Sleeping WellFAC001-Botheredby Treatment Side EffectFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

7938STUDYXQS2324-P00012638FAC01526FAC00106FAC015FAC001-Enjoy Things I Usually Do for FunI Feel IllFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

8039STUDYXQS2324-P00012739FAC01527FAC00107FAC015-Content With Quality of My LifeFAC001-I Am Forced to Spend Time in BedFACT-HEP G V4FUNCTIONAL PHYSICAL WELL-BEING


NOT DONE

2

8140STUDYXQS2324-P00012840FAC01528FAC00108FAC015-Swelling/Cramps in Stomach AreaFAC001-I Feel Close to My FriendsFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8241STUDYXQS2324-P00012941FAC01529FAC00109FAC015-I Am Losing WeightFAC001-Get Emotional Support From FamilyFACT-HEP V4G V4SOCIAL/FAMILY WELL-BEINGADDITIONAL CONCERNS


NOT DONE

2

8342STUDYXQS2324-P00013042FAC01530FAC00110FAC015FAC001-I Have Control of My BowelsGet Support From FriendsFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8443STUDYXQS2324-P00013143FAC01531FAC00111FAC015-I Can Digest My Food WellFAC001-My Family Has Accepted My IllnessFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8544STUDYXQS2324-P00013244FAC01532FAC00112FAC015-I Have DiarrheaFAC001-Satisfied Communication IllnessFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8645STUDYXQS2324-P00013345FAC01533FAC00113FAC015FAC001-I Have a Good AppetiteFeel close to My PartnerFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8746STUDYXQS2324-P00013446FAC01534FAC00114FAC015-Unhappy About Change in My AppearFAC001-I Am Satisfied With My Sex LifeFACT-HEP G V4ADDITIONAL CONCERNSSOCIAL/FAMILY WELL-BEING


NOT DONE

2

8847STUDYXQS2324-P00013547FAC01535FAC00115FAC015FAC001-I Have Pain in My BackFeel SadFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

8948STUDYXQS2324-P00013648FAC01536FAC00116FAC015FAC001-Satisfied With How I Am Bothered by ConstipationCopingFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

9049STUDYXQS2324-P00013749FAC01537FAC00117FAC015-I Feel FatiguedFAC001-Losing Hope Against IllnessFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

9150STUDYXQS2324-P00013850FAC01538FAC00118FAC015-Able to Do My Usual ActivitiesFAC001-I Feel NervousFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

9251STUDYXQS2324-P00013951FAC01539FAC00119FAC015-Bothered by Jaundice/Yellow SkinFAC001-I Worry About DyingFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

9352STUDYXQS2324-P00014052FAC01540FAC00120FAC015-I Have Had FeversFAC001-Worry My Condition Will Get WorseFACT-HEP G V4ADDITIONAL CONCERNSEMOTIONAL WELL-BEING


NOT DONE

2

9453STUDYXQS2324-P00014153FAC01541FAC00121FAC015FAC001-I Have Had ItchingAm Able to WorkFACT-HEP G V4ADDITIONAL CONCERNSFUNCTIONAL WELL-BEING


NOT DONE

2

9554STUDYXQS2324-P00014254FAC01542FAC00122FAC015-Had Change in the Way Food TastesFAC001-My Work Is FulfillingFACT-HEP G V4ADDITIONAL CONCERNSFUNCTIONAL WELL-BEING


NOT DONE

2

9655STUDYXQS2324-P00014355FAC01543FAC00123FAC015FAC001-I Have Had ChillsAm Able to Enjoy LifeFACT-HEP G V4ADDITIONAL CONCERNSFUNCTIONAL WELL-BEING


NOT DONE

2

9756STUDYXQS2324-P00014456FAC01544FAC00124FAC015FAC001-My Mouth Is DryI Have Accepted My IllnessFACT-HEP G V4ADDITIONAL CONCERNSFUNCTIONAL WELL-BEING


NOT DONE

2

9857STUDYXQS2324-P00014557FAC01545FAC00125FAC015-Discomfort/Pain in Stomach AreaFAC001-I Am Sleeping WellFACT-HEP G V4ADDITIONAL CONCERNSFUNCTIONAL WELL-BEING


NOT DONE

2

9958STUDYXQS2324-P00014658FAC01546FAC00126FAC015-Physical Subscale ScoreFAC001-Enjoy Things I Usually Do for FunFACT-HEP G V4FUNCTIONAL WELL-BEING


NOT DONE

2

10059STUDYXQS2324-P00014759FAC01547FAC00127FAC015-Social/Family Subscale ScoreFAC001-Content With Quality of My LifeFACT-HEP G V4FUNCTIONAL WELL-BEING


NOT DONE

2

10160STUDYXQS2324-P00014860FAC01548FAC015-Emotional Subscale ScoreFACT-HEP V4NOT DONE2102STUDYXQS2324-P000149FAC01549

FAC00128

Jira
showSummaryfalse
serverIssue Tracker (JIRA)
serverId85506ce4-3cb3-3d91-85ee-f633aaaf4a45
keyQRSSUPP-668

FAC001-Physical FAC015-Functional Subscale ScoreFACT-HEP G V4



NOT DONE

2

10361STUDYXQS2324-P00015061FAC01550FAC00129FAC015-Additional Concern FAC001-Social/Family Subscale ScoreFACT-HEP G V4



NOT DONE

2

10462STUDYXQS2324-P00015162FAC01551FAC00130FAC015-Trial Outcome Index FAC001-Emotional Subscale ScoreFACT-HEP G V4



NOT DONE

2

10563STUDYXQS2324-P00015263FAC01552FAC00131FAC015-FACT-G Total FAC001-Functional Subscale ScoreFACT-HEP G V4



NOT DONE

2

10664STUDYXQS2324-P00015364FAC01553FAC00132FAC015FAC001-Total ScoreFACT-HEP G V4



NOT DONE

2


4 SDTM Mapping Strategy

This section is used for reference regarding the CRF data capture and to understand the alignment of the instrument to the SDTM QS domain. It also provides guidance on how the result variables (QSORRES, QSSTRESC, and QSSTRESN) should be populated.

QSSCAT alignment with QSTESTCD

As stated in Section 3.1 assumptions, Assumptions, items on the FACT-HEP G V4 are grouped into subcategories. The following table below includes the subcategory names along with the applicable item numbers for each category. The values of the subcategories are used to populate QSSCAT and are annotated on the CRF.

FAC01528 - FAC01545
QSSCATQSTESTCD
PHYSICAL WELL-BEINGFAC01501 FAC00101 - FAC01507FAC00107
SOCIAL/FAMILY WELL-BEINGFAC01508 FAC00108 - FAC01514FAC00114
EMOTIONAL WELL-BEINGFAC01515 FAC00115 - FAC01520FAC00120
FUNCTIONAL WELL-BEINGFAC01521 - FAC01527ADDITIONAL CONCERNSFAC00121 - FAC00127


All QSTESTCDs

QSORRES

QSSTRESC

QSSTRESN

Not at all00
A little bit11
Somewhat22
Quite a bit33
Very much44

...