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PBI-W – Patient Benefit Index, wound version

Importance of Treatment Goals

Please help us understand the importance of your goals in the current treatment of your wound/wounds by filling out the following survey.

For each of the following statements, please mark how important this treatment goal is to you. If a statement does not apply to you (for example, because you do not have pain), please mark "does not apply to me“. Please mark only one answer choice per statement.

As a result of therapy, how important is it for you to...

not at all

somewhat

moderately

quite

very

does not apply to me

1) ...be free from pain

does not apply to me

2) ...have no drainage from the wound(s)

3) ...not have an unpleasant smell from the wound(s)

not at all

somewhat

4) ...be healed from the wound(s)

5) ...be able to sleep better

moderately

6) ...feel less depressed

7) ...experience greater enjoyment of life

8) ...not be afraid that the problem(s) will get worse

9) ...be able to lead a normal life

10) ...be more productive in everyday life

11) ...not be a burden to friends and family

12) ...be able to enjoy your spare time like a normal person

13) ...be able to lead a normal working life

14) ...be able to have more contact with other people

15) ...be more comfortable being out in public

16) ...not have the relationship with your partner affected by the wound

17) ...not have to rely on doctor visits

18) ...not spend so much time taking care of these problems

19) ...not have to spend so much of your own money on treatment

20) ...have fewer side effects

21) ...feel certain about the diagnosis and therapy

22) ...feel certain that the treatment will work

Please review your answers to make sure you have marked each statement with an "x."

Our sincerest thanks for your cooperation!

No goals

High goals

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PBI-W – Patient Benefit Index, wound version

Importance of Treatment Goals

As a result of therapy, how important is it for you to...

The total value of your goals: