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NET Treatment and Wellness Plan Pilot - Patient Evaluation
We would love to hear your feedback - please take a moment to share your thoughts below
1.
What is your gender?
Male
Female
Other (please specify)
2.
Which category below includes your age?
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
3.
Do you live in a metropolitan or rural area?
Metropolitan (within one hour drive of capitol city centre)
Regional (over one hour drive from capitol city centre)
4.
Are you of Aboriginal or Torres Strait Islander heritage?
No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both Aboriginal and Torres Strait Islander
5.
What statement best describes your current situation?
I have completed my treatment for NETs
I am having ongoing treatment (e.g. Sandostatin/Lanreotide injections)
Other (please describe)
6.
How did you hear about the treatment and wellness plan? (select all that apply)
Unicorn Foundation E-News
Unicorn Foundation Website
Unicorn Foundation Facebook Page
Unicorn Foundation Facebook Private Discussion Group
Unicorn Foundation NET Nurse
Australian Cancer Survivorship Centre
Other Health Professional
Support Group
Other (please specify)
7.
Who completed your treatment and wellness plan? (select all that apply)
Specialist (e.g. Oncologist)
Care coordinator (e.g. Nurse)
GP
Self-completed
Other (please specify)
8.
Please tell us how much you agree with the following statements about the treatment and wellness plan:
Strongly disagree
Strongly agree
N/A
I had a thorough record of my treatment and investigations to date
Strongly disagree
Strongly agree
N/A
I understood my plan of treatment
Strongly disagree
Strongly agree
N/A
I had a record of, and understood future investigations/ monitoring
Strongly disagree
Strongly agree
N/A
I had a record of other professionals involved in my care
Strongly disagree
Strongly agree
N/A
I had a record of how and when to contact other health professionals
Strongly disagree
Strongly agree
N/A
I had adequate information about maintaining and improving my general health
Strongly disagree
Strongly agree
N/A
The plan reduced my worries about my condition
Strongly disagree
Strongly agree
N/A
The plan helped me know how I can contribute to the management of my condition
Strongly disagree
Strongly agree
N/A
The plan encouraged me to become more active in order to improve my condition
Strongly disagree
Strongly agree
N/A
Comments
9.
Overall, how satisfied were you with this document?
Not at all satisfied
Extremely satisfied
Not at all satisfied
Extremely satisfied
10.
In what format would you prefer this plan? (please select all that apply)
Paper based
Online
Via an app
Comments
11.
Would you envisage sharing this document with your GP?
Yes
No
Comments
12.
Is there anything you would change about the document?
Yes
No
Comments:
13.
Thank you for your feedback. Is there anything else you would like to add?
We would love you to join us for our next webinar which will look at diagnostic imaging in NETs.
Stay tuned for more information via our website or Facebook page very soon!
14.
If a health professional helped you complete your plan, would you be happy to share their details so we can ask them what they think?
Name
Hospital/organisation
Email Address
Phone Number