St. Joseph Hospital Survey for Survivors of Cancer

1. St. Joseph Hospital's Cancer Survivorship Survey

 
The purpose of this survey is to identify services cancer survivors may need over their lifetime. It is being conducted by the Cancer Institute at St. Joseph's Hospital.

The survey may be completed by a survivor of childhood cancer (ages 1 - 18), young adult cancer (ages 15 – 30), or adult cancer (ages 30 and above). It may be filled out by a parent, husband, wife or partner, brother or sister, close friend, or paid caretaker of a cancer survivor. It may also be filled out by a doctor, nurse, or other health care professional who serves cancer survivors.

Thank you for taking the time to answer the questions that follow. You answers will help us develop a comprehensive program for cancer survivors.
1. Which descriptions (you can check more than one) apply to you?
2. Please name the survivor's type of cancer
3. When was the survivor first diagnosed with this cancer? (include month, day, and year)
4. If the cancer treatment ended, please tell us when it ended (include month, day, and year).
5. If the survivor is still being treated, tell us when treatment will be completed (include month, day, and year).
6. Please name the hospital, city and state where the survivor was treated or is still being treated for this cancer?
7. Today, what is the survivor's age in years:
8. What is the name of the doctor(s) who have treated (or are treating) the survivor for this cancer?
9. Optional Question: Please provide us your full name and email address and/or telephone number if you would like to get a copy of the results of this survey. Also in the fourth box indicate if you would be willing to participate in a Focus Group concerning the development of a comprehensive Cancer Survivorship Program after the results of this survey have been analyzed
10. Listed below are services survivors may need over their lifetime. Please rate on a scale from 1-10 how important each service is or might be to the survivor. “1” means the survivor does not need this service at all. “10” means the survivor needs this service very much.
Not needed at allNeeded very much
1. To be known as a survivor from the time they are first told they had cancer and for the rest of their lives
2. Doctors and nurses who listen and understand when they talk about their worries and concerns throughout their lives
3. To have a nurse in the hospital and clinic, known as a Navigator Nurse, to help guide survivors through the health care system and their journey through cancer treatment
4. Health education concerning their cancer, treatment, side effects of treatment and late effects of treatment
5. Training on ways to improve survivor’s follow through with required medical treatment during and after cancer treatment
6. Support groups, designed for different age groups and types of cancer, for survivors and care givers to attend during and after cancer treatment
7. Internet Chat Rooms for survivors and care givers to use for support and to share information with other people at their same stage of cancer survival
8. A web site which provides ongoing up to date information on cancer, treatments, late effects and ways to cope with the realities of cancer
9. To receive follow-up care for life by an oncology team of doctors, nurses, and other health care professionals
10. To have a medical clinic dedicated to their health needs through out their lives
11. Education programs and services offered to help survivors learn about life long aspects of their cancer and its treatment
12. An information library with handouts for cancer survivors
13. A community resource center with all kinds of support services for cancer survivors
14. Services designed for different age groups to deal with the sexual side effects of cancer treatment
15. Services offered by social workers and case managers to help with lifelong problems or concerns that result from having cancer - such as personal, family, money, social or education issues
16. Mental health services to help cope with lifelong problems or concerns that result from having cancer - such as psychological testing, personal, family or marriage counseling
17. Faith based services to help with lifelong problems or concerns from having cancer
18. Rehabilitation services to help with recovery from the effects of cancer treatment
19. Services to help address food and nutrition needs from the effects of cancer treatment
20. Integrative medicine services to support recovery such as art and music therapy, meditation and yoga, acupuncture and acupressure, massage and reflexology, pain management, diet and herbal counseling
11. Listed below are information topics survivors may need to learn about over their lifetime. Please rate on a scale from 1-10 how important each service is or might be to the survivor. “1” means the survivor does not need this information at all. “10” means the survivor needs this information very much.
Not needed at allNeed very much
1. The specific cancer, its treatments, and side effects
2. Chemotherapy treatments used for this cancer
3. Radiation treatment used for this cancer
4. Surgery used for treating this cancer
5. The late effects of treatment of this cancer
6. How to survive this cancer
7. What facts need to be written down and saved for their health records before and after treatment
8. Services available to survivors with this type of cancer during treatment, after treatment, and for the rest of their lives
9. How to obtain medical insurance and life insurance after the cancer treatment ends
10. Medical care options that may be available after treatment to have as a safety net to deal with health care problems that may occur
11. Steps to be taken to maintain a healthy lifestyle after treatment
12. Nutrition information to maintain a healthy diet during and after cancer treatment
13. Exercise and physical activity information to maintain good health after treatment
14. Information about coping and dealing with the aftermath of cancer
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