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Workshop Attendee Survey - Immunotherapy - Archived
Affiliate
- Select -
(Disaffiliated) GC New Hampshire
(Disaffiliated) HP Northwest Medical Specialties
(Disaffiliated) HP Orlando Health Cancer Institute
CSC Arizona
CSC Atlanta
CSC California Central Coast
CSC Central Ohio
CSC Central Ohio - Archived
CSC DC
CSC Delaware
CSC East Tennessee
CSC Greater Ann Arbor
CSC Greater Cincinnati - Northern Kentucky
CSC Greater Lehigh Valley
CSC Greater NY and CT at GC
CSC Greater Philadelphia
CSC Greater San Gabriel Valley
CSC Greater St. Louis
CSC Headquarters
CSC Indiana
CSC Iowa & NW Illinois at GC
CSC Los Angeles
CSC Massachusetts
CSC Montana
CSC New Jersey
CSC North Texas
CSC Rochester
CSC San Francisco Bay Area
CSC South Bay
CSC Southwest Colorado
CSC Valley/Ventura/Santa Barbara
GC Chicago
GC Grand Rapids
GC Greater Toronto
GC Kansas City
GC Kentuckiana
GC Madison
GC Metro Detroit
GC Middle Tennessee
GC Minnesota
GC Simcoe Muskoka
GC South Florida
HP Breckinridge Health, Inc.
HP Community Infusion Solutions (CIS)
HP Holy Name Medical Center
HP IFHC
HP Kona Community Hospital
HP Methodist Cancer Institute
HP Mosaic Life Care
HP Prisma Health Cancer Institute
HP Rocky Mountain Cancer Centers
HP Tuba City Regional Health
HP Whitman-Walker Health
Workshop Date
I attended as a:
Person with cancer/Cancer Survivor
Spouse/Partner
Family member
Health care professional
Friend
Other…
Enter other…
Race/Ethnicity (Check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other…
Enter other…
How old are you?
What is your gender identity?
Male
Female
Transgender male/Trans man
Transgender female/Trans woman
Not listed
(please specify)
What is the highest level of education you have completed?
Some high school
High school diploma or equivalent (GED)
Some college
Bachelor’s degree
Technical / Vocational / Associate’s degree
Master’s degree or higher
Which of the following best describes the area you live in?
Urban
Suburban
Rural
I have experienced emotional distress due to my/my loved one’s cancer.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The social and emotional effects of cancer, and their impact on my life, have been adequately addressed by my health care team.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
How knowledgeable were you about immunotherapy BEFORE this workshop?
1 (Not at all)
2
3
4
5 (Very much)
How knowledgeable are you about immunotherapy AFTER this workshop?
1 (Not at all)
2
3
4
5 (Very much)
Before this workshop I:
Made treatment decisions in partnership with my health care team
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
Asked my doctor about ways to deal with and manage side effects of cancer treatment
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
Asked my doctor about potential clinical trials available to me
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
Searched for information on immunotherapy
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
Spoke with my doctor about immunotherapy treatment options
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
Knew about the potential side effects of immunotherapy
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
As a result of this workshop:
I am confident I can make treatment decisions in partnership with my health care team.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I am confident I can ask my health care team questions about side effects of cancer and its treatment.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I am confident asking my doctor about potential clinical trials available to me
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I am confident searching for more information on immuontherapy
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I am confident speaking with my doctor about immunotherapy treatment options
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I am confident talking to my doctor about the potential side effects of immunotherapy
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Not Applicable
I would recommend this workshop to others with cancer and their loved ones.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Besides workshops, where do you seek information about cancer treatments? (Check all that apply)
Doctor/Nurse
Internet
Friends/Family
Other Patients
Print Materials
Webinars
Media (TV, Radio)
Support Groups
Social Network Sites
Support Organizations
Nowhere else
Other…
Enter other…
General comments or suggestions about the workshop (i.e. are there other topics not covered in this workshop that you would be interested in, etc.):
If you are a person with cancer / cancer survivor, please answer the remaining items.
What was your primary cancer diagnosis?
Breast
Colorectal
Gynecologic
Brain
Prostate
Lung
Multiple Myeloma
Lymphoma
Skin
Blood
Other…
Enter other…
Do you have metastatic/advanced cancer?
Yes
No
Not Sure
How long has it been since you were first diagnosed with cancer?
Less than 3 months
3-6 months
7-12 months
13 months - 2 years
2-5 years
More than 5 years
Are you currently in active treatment for your cancer?
Yes
No
What kind of treatment have you received/are you currently receiving? (Check all that apply)
Surgery
Chemotherapy
Radiation
Targeted Therapy
Complementary/Alternative Therapy
Immunotherapy/Cellular Therapy
Clinical Trial
No Treatment
Other…
Enter other…
Please consider joining the Cancer Experience Registry at www.CancerExperienceRegistry.org It is a place where you can share your voice and learn from others while helping shape new programs, research and policy for those living with cancer. If you would like to receive additional information on the Registry or on the educational materials we offer, please provide your first name and e-mail address.
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