BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet Test: Family Impact Survey Year: 1994 Domain: Social Assessment Tool Category: Caregiving, Social Support Variations/Translations: N/A Setting: Home or clinical Method of Delivery: In-person interview Description: The Family Impact Survey is a 10-item questionnaire that was designed to measure the impact of a person’s illness as perceived by family members. Responses from family members are considered to be the primary responses, although both the patient and the patient’s family members are interviewed. The Family Impact Survey identifies if a negative financial or caregiving burden impact has been experienced by a patient’s family members (Covinsky et al., 1994). Scoring/Interpretation: Question 1 has a four point response choice, from “a great deal” to “none at all.” Questions 2 and 4-9 have Yes/No response choices. Questions 3 and 10 ask for qualitative details in reference to the previous question. The survey is not designed to be ‘scored’ per se; rather, individual response choices should point towards areas of adverse impact of illness (Covinsky et al., 1994). Time to Administer: 10 minutes Availability: Available in the original source article (Covinsky et al., 1994). Software: N/A Website: N/A Quantitative/Qualitative: Quantitative and qualitative Validity (Quantitative): Not tested. Reliability (Quantitative): Not tested. References: Covinsky, K. E., Goldman, L., Cook, E. F., Oye, R., Desbiens, N., Reding, D., et al. (1994). The Impact of Serious Illness on Patients' Families. JAMA, 272(23), 839-1844. Comments: Validity and reliability testing has not yet been assessed.