Drawing from decades of experience reflected in published literature and previous work of the investigators, PROMIS began the item bank development by cataloguing items from well-established instruments that had been extensively tested and had excellent track records. PROMIS investigators across the network conducted inclusive searches and evaluations of existing instruments to enrich the pool of domain-relevant items that were considered potential candidates for the PROMIS item banks. Searches started with MEDLINE and Health and Psychosocial Instruments, but also included proprietary databases like Patient-Reported Outcome and Quality of Life Instruments Database (PROQOLID). Each domain work-group constructed their own search strategy based upon the specific needs identified within the domain. For example, the Emotional Distress domain group identified 4 general areas (referred to as “subdomains”) for starting bank development: depression, anxiety, anger, and substance misuse. They created search strategies to identify all known items covering these topics as a starting point for PROMIS banks. Importantly, the process allowed manual searches of files by investigators to identify items that were not found through the database searches. For example, the Statistical Coordinating Center (SCC) had accumulated databases of items in a variety of domains in which they had researched previously. The SCC made these item lists available to PROMIS researchers. At this stage of the process, items were not filtered out if they applied to a specific population; such items were kept for further qualitative analysis. By performing these searches, PROMIS investigators identified thousands of items relevant to the domains PROMIS was trying to measure. At that point, no judgment was made regarding the quality or redundancy of the items; they were only selected if their content fit or were deemed proximal to the domain definitions.