Confidential Penile Cancer Survey

3. Please tell us about yourself by ticking the relevant box.

Please tell us about yourself by ticking the relevant box. I have penile cancer/I have had penile cancer

I am a carer/family member or friend of somebody with penile cancer or a carer/family member or friend of somebody who has had penile cancer

I am a Healthcare Professional

I am interested in penile cancer

Other (please specify)

4. Where do you live?

Where do you live? North East

North West

Yorkshire and the Humber

East Midlands

West Midlands

East of England

London

South Central

South East Coast

South West

Scotland

Wales

Northern Ireland

5. Would you find it helpful to talk to someone over the phone about issues relating to penile cancer? (Please tick any that apply)

Would you find it helpful to talk to someone over the phone about issues relating to penile cancer? (Please tick any that apply) Yes, another patient with experience of penile cancer

Yes, a nurse who has specialist knowledge of penile cancer

Yes, a trained counsellor

Yes, an information officer who can provide general information on a range of topics and referrals to other specialist services

No (please go straight to question 7)

6. If you think a telephone based service would be helpful, which of the following topics would you most like to talk about?

	Yes, definitely	Yes, probably	Maybe/unsure	No
Questions about diagnosis and treatment options	*If you think a telephone based service would be helpful, which of the following topics would you most like to talk about? Questions about diagnosis and treatment options Yes, definitely	Questions about diagnosis and treatment options Yes, probably	Questions about diagnosis and treatment options Maybe/unsure	Questions about diagnosis and treatment options No
Treatment side effects and aftercare	Treatment side effects and aftercare Yes, definitely	Treatment side effects and aftercare Yes, probably	Treatment side effects and aftercare Maybe/unsure	Treatment side effects and aftercare No
Reconstruction	Reconstruction Yes, definitely	Reconstruction Yes, probably	Reconstruction Maybe/unsure	Reconstruction No
Relationships	Relationships Yes, definitely	Relationships Yes, probably	Relationships Maybe/unsure	Relationships No
Sexual issues	Sexual issues Yes, definitely	Sexual issues Yes, probably	Sexual issues Maybe/unsure	Sexual issues No
Emotional/psychological support	Emotional/psychological support Yes, definitely	Emotional/psychological support Yes, probably	Emotional/psychological support Maybe/unsure	Emotional/psychological support No
Pain management	Pain management Yes, definitely	Pain management Yes, probably	Pain management Maybe/unsure	Pain management No
Practical issues including urinating, underwear	Practical issues including urinating, underwear Yes, definitely	Practical issues including urinating, underwear Yes, probably	Practical issues including urinating, underwear Maybe/unsure	Practical issues including urinating, underwear No
Lymphedema and swelling	Lymphedema and swelling Yes, definitely	Lymphedema and swelling Yes, probably	Lymphedema and swelling Maybe/unsure	Lymphedema and swelling No
How to access benefits or other services	How to access benefits or other services Yes, definitely	How to access benefits or other services Yes, probably	How to access benefits or other services Maybe/unsure	How to access benefits or other services No
How to talk to your employer about your illness	How to talk to your employer about your illness Yes, definitely	How to talk to your employer about your illness Yes, probably	How to talk to your employer about your illness Maybe/unsure	How to talk to your employer about your illness No
How to talk to family and friends about penile cancer	How to talk to family and friends about penile cancer Yes, definitely	How to talk to family and friends about penile cancer Yes, probably	How to talk to family and friends about penile cancer Maybe/unsure	How to talk to family and friends about penile cancer No
Latest research developments	Latest research developments Yes, definitely	Latest research developments Yes, probably	Latest research developments Maybe/unsure	Latest research developments No
Treatments that are under development	Treatments that are under development Yes, definitely	Treatments that are under development Yes, probably	Treatments that are under development Maybe/unsure	Treatments that are under development No
Other medical questions	Other medical questions Yes, definitely	Other medical questions Yes, probably	Other medical questions Maybe/unsure	Other medical questions No

7. Do you feel there is a need to provide more dedicated services and information about penile cancer?

Do you feel there is a need to provide more dedicated services and information about penile cancer? Yes

8. If you answered Yes to question 7, which of the following would you like to use or would you have found most useful?

	Very useful	Useful	Maybe/unsure	Not useful
A confidential telephone service specialising in male cancer, led by a dedicated nurse who understands your needs	*If you answered Yes to question 7, which of the following would you like to use or would you have found most useful? A confidential telephone service specialising in male cancer, led by a dedicated nurse who understands your needs Very useful	A confidential telephone service specialising in male cancer, led by a dedicated nurse who understands your needs Useful	A confidential telephone service specialising in male cancer, led by a dedicated nurse who understands your needs Maybe/unsure	A confidential telephone service specialising in male cancer, led by a dedicated nurse who understands your needs Not useful
Factsheets and leaflets on specialist subjects e.g. reconstruction	Factsheets and leaflets on specialist subjects e.g. reconstruction Very useful	Factsheets and leaflets on specialist subjects e.g. reconstruction Useful	Factsheets and leaflets on specialist subjects e.g. reconstruction Maybe/unsure	Factsheets and leaflets on specialist subjects e.g. reconstruction Not useful
Email discussion group / Web-based forum / chat room / message board	Email discussion group / Web-based forum / chat room / message board Very useful	Email discussion group / Web-based forum / chat room / message board Useful	Email discussion group / Web-based forum / chat room / message board Maybe/unsure	Email discussion group / Web-based forum / chat room / message board Not useful
Face-to-face meetings / social/group support	Face-to-face meetings / social/group support Very useful	Face-to-face meetings / social/group support Useful	Face-to-face meetings / social/group support Maybe/unsure	Face-to-face meetings / social/group support Not useful
Information day led by Healthcare Professionals	Information day led by Healthcare Professionals Very useful	Information day led by Healthcare Professionals Useful	Information day led by Healthcare Professionals Maybe/unsure	Information day led by Healthcare Professionals Not useful
DVD	DVD Very useful	DVD Useful	DVD Maybe/unsure	DVD Not useful

9. If you have any other comments, or there are any other services you would benefit from that have not been mentioned above, please use this box to tell us about them.

If you have any other comments, or there are any other services you would benefit from that have not been mentioned above, please use this box to tell us about them.

Confidential Penile Cancer Survey
Exit this survey

Orchid Penile Cancer Survey

1. Are you:

2. What is your age?

3. Please tell us about yourself by ticking the relevant box.

4. Where do you live?

5. Would you find it helpful to talk to someone over the phone about issues relating to penile cancer? (Please tick any that apply)

6. If you think a telephone based service would be helpful, which of the following topics would you most like to talk about?

7. Do you feel there is a need to provide more dedicated services and information about penile cancer?

8. If you answered Yes to question 7, which of the following would you like to use or would you have found most useful?

9. If you have any other comments, or there are any other services you would benefit from that have not been mentioned above, please use this box to tell us about them.

Confidential Penile Cancer SurveyExit this survey

Orchid Penile Cancer Survey

1. Are you:

2. What is your age?

3. Please tell us about yourself by ticking the relevant box.

4. Where do you live?

5. Would you find it helpful to talk to someone over the phone about issues relating to penile cancer? (Please tick any that apply)

6. If you think a telephone based service would be helpful, which of the following topics would you most like to talk about?

7. Do you feel there is a need to provide more dedicated services and information about penile cancer?

8. If you answered Yes to question 7, which of the following would you like to use or would you have found most useful?

9. If you have any other comments, or there are any other services you would benefit from that have not been mentioned above, please use this box to tell us about them.

Confidential Penile Cancer Survey
Exit this survey