title: Pictorial Representation of Self and Illness Measure (PRISM): a graphic instrument to assess suffering in fatigued cancer survivors.
abstract: OBJECTIVE
  The Pictorial Representation of Self and Illness Measure (PRISM) measures in a simple, graphic way the burden of suffering due to illness. The question addressed in this study is whether the PRISM is a valid instrument to measure suffering in cancer survivors experiencing severe fatigue.
  
  
  METHODS
  Quantitative and qualitative data of a previous randomized controlled trial demonstrating the efficacy of cognitive behavior therapy (CBT) especially designed for postcancer fatigue was used to assess convergent validity and sensitivity to change in a sample of 83 cancer survivors.
  
  
  METHODS
  The PRISM, yielding self-illness separation (SIS-fatigue = suffering due to fatigue; SIS-cancer = suffering due to cancer), fatigue severity (Checklist Individual Strength; CIS-fatigue), functional impairment, psychological well-being, quality of life, and coping with the experience of cancer (Impact of Event Scale; IES).
  
  
  RESULTS
  Moderate significant correlations were found with the PRISM and the above-mentioned measures. On the basis of SIS scores, the sample was divided into two separate groups: cancer survivors who suffered more because of fatigue and cancer survivors who suffered more because they had cancer in the past. The two groups had different scores on CIS-fatigue and IES, in line with that aspect that caused them the most suffering. The qualitative data confirmed this finding. Participants in the CBT condition demonstrated a significant difference between SIS-fatigue at baseline versus 6 months later compared with those in the waiting list condition. No change of SIS-cancer was found.
  
  
  CONCLUSIONS
  The PRISM seems to be a valuable tool in fatigue research and clinical practice.
authors: Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. m.gielissen@mps.umcn.nl
authors: Marieke F M
authors: MF
authors: Gielissen
authors: Judith B
authors: JB
authors: Prins
authors: Hans
authors: H
authors: Knoop
authors: Stans
authors: S
authors: Verhagen
authors: Gijs
authors: G
authors: Bleijenberg
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005221:Fatigue / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D011795:Surveys and Questionnaires / Q000592:standards*; D017741:Survivors / Q000523:psychology*; D055815:Young Adult