YOUR VIEWS ABOUT YOUR CP

Listed below are a number of symptoms that you may or may not have experienced since your CP.
Please indicate by circling Yes or No, whether you have experienced any of these symptoms since
your CP, and whether you believe that these symptoms are related to your CP.

I have experienced this This symptom is related to my

Pain Yes No ____________________ Yes No

Sore Throat Yes No ____________________ Yes No

Nausea Yes No ____________________ Yes No

Breathlessness Yes No ____________________ Yes No

Weight Loss Yes No ____________________ Yes No

Fatigue Yes No ____________________ Yes No

Stiff Joints Yes No ____________________ Yes No

Sore Eyes Yes No ____________________ Yes No

Wheeziness Yes No ____________________ Yes No

Headaches Yes No ____________________ Yes No

Upset Stomach Yes No ____________________ Yes No

Sleep Difficulties Yes No ____________________ Yes No

Dizziness Yes No ____________________ Yes No

Loss of Strength Yes No ____________________ Yes No

We are interested in your own personal views of how you now see your current CP.

Please indicate how much you agree or disagree with the following statements about your CP by
ticking the appropriate box.

STRONGLY DISAGREE NEITHER AGREE STRONGLY

IP1*
My CP will last a short time
IP2
My CP is likely to be permanent rather than
temporary
IP3
My CP will last for a long time
IP4*
This CP will pass quickly
 STRONGLY DISAGREE NEITHER AGREE STRONGLY
VIEWS ABOUT YOUR CP DISAGREE AGREE NOR AGREE
DISAGREE

IP5*
I expect to have this CP for the rest of my life
IP6
My CP is a serious condition
IP7
My CP has major consequences on my life
IP8*
My CP does not have much effect on my life
IP9
My CP strongly affects the way others see me
IP10
My CP has serious financial consequences
IP11
My CP causes difficulties for those who are
close to me
IP12
There is a lot which I can do to control my
symptoms
IP13
What I do can determine whether my CP gets
better or worse
IP14
The course of my CP depends on me
IP15*
Nothing I do will affect my CP
IP16
I have the power to influence my CP
IP17*
My actions will have no affect on the outcome
of my CP
IP18*
My CP will improve in time
IP19*
There is very little that can be done to
improve my CP
IP20
My treatment will be effective in curing my
CP
IP21
The negative effects of my CP can be
prevented (avoided) by my treatment
IP22
My treatment can control my CP
IP23*
There is nothing which can help my condition
IP24
The symptoms of my condition are puzzling to
me
IP25
My CP is a mystery to me
IP26
I don== t understand my CP
IP27
My CP doesn== t make any sense to me
IP28*
I have a clear picture or understanding of my
condition
IP29
The symptoms of my CP change a great deal
from day to day
 from day to day
IP30
My symptoms come and go in cycles
IP31
My CP is very unpredictable
IP32
I go through cycles in which my CP gets better
and worse.
IP33
I get depressed when I think about my CP
IP34
When I think about my CP I get upset
IP35
My CP makes me feel angry
IP36*
My CP does not worry me
IP37
Having this CP makes me feel anxious
IP38
My CP makes me feel afraid
 CAUSES OF MY CP

We are interested in what you consider may have been the cause of your CP. As people are very different,
there is no correct answer for this question. We are most interested in your own views about the factors that
caused your CP rather than what others including doctors or family may have suggested to you. Below is a
list of possible causes for your CP. Please indicate how much you agree or disagree that they were causes for
you by ticking the appropriate box.

STRONGLY DISAGREE NEITHER AGREE STRONGLY

C1
Stress or worry
C2
Hereditary - it runs in my family
C3
A Germ or virus
C4
Diet or eating habits
C5
Chance or bad luck
C6
Poor medical care in my past
C7
Pollution in the environment
C8
My own behaviour
C9
My mental attitude e.g. thinking about life
negatively
C10
Family problems or worries
C11*
Overwork
C12*
My emotional state e.g. feeling down, lonely,
anxious, empty
C13*
Ageing
C14*
Alcohol

Smoking
C15*

C16*
Accident or injury
C17*
My personality
C18*
Altered immunity

In the table below, please list in rank-order the three most important factors that you now believe caused
YOUR CP. You may use any of the items from the box above, or you may have additional ideas of your own.

The most important causes for me:-

1. _______________________________________

2. _______________________________________

3. _______________________________________