Cancer in the Family Primary Care Matters Survey

As part of registering for "Cancer in the family: primary care matters", and in order to help us to improve future events, please complete the following survey. The information provided herein will only be used for reporting back to our grantor. Contact and demographic information will be shared with third parties.

****The link to conference videos is at the end of this survey.****

MaineGeneral Medical Center's Institutional Review Board has exempted this project from IRB oversight.

Thank you

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* 1. Contact Info

Name: *

Company: *

City/Town:

State:

Email Address: *

Phone Number:

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* 2. Your gender:

Female

Male

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* 3. Please indicate your degree type

MPH

PHD

Other (please specify)

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* 4. What is your specialty?

Family Medicine

General Internal Medicine

Obstetrics and gynecology

Pediatrics

Surgery

Oncology

Pathology

Other (please specify)

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* 5. What is your age range:

15-24

25-34

35-44

45-54

55-64

64+

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* 6. How many years have you been in practice?

Student

Resident

Less than 5

5-10

10-20

20-30

30+

Other (please specify)

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* 7. On average, what percentage of your work is direct patient care?

0-19%

20-39%

40-59%

60-79%

80-100%

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* 8. I can effectively screen my patients for an inherited risk of cancer

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

Not applicable

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* 9. I consider screening my patients for an inherited risk of cancer important to my practice.

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

Not applicable

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* 10. On average, how many patients do you see a month with strong cancer family histories?

0-4

5-10

>10

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* 11. In general, consider your patients who have a family history of cancer. Assume they underwent testing and learned that they had a high risk of developing that cancer sometime in the future. In general would you be more or less likely to do the following:

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree	Not applicable
a. Increase the pursuit of screening for that cancer?	a. Increase the pursuit of screening for that cancer? Strongly Agree	a. Increase the pursuit of screening for that cancer? Somewhat Agree	a. Increase the pursuit of screening for that cancer? Somewhat Disagree	a. Increase the pursuit of screening for that cancer? Strongly Disagree	a. Increase the pursuit of screening for that cancer? Not applicable
b. Increase the pursuit of screening for other diseases?	b. Increase the pursuit of screening for other diseases? Strongly Agree	b. Increase the pursuit of screening for other diseases? Somewhat Agree	b. Increase the pursuit of screening for other diseases? Somewhat Disagree	b. Increase the pursuit of screening for other diseases? Strongly Disagree	b. Increase the pursuit of screening for other diseases? Not applicable
c. Work to help the patients improve their diet and exercise?	c. Work to help the patients improve their diet and exercise? Strongly Agree	c. Work to help the patients improve their diet and exercise? Somewhat Agree	c. Work to help the patients improve their diet and exercise? Somewhat Disagree	c. Work to help the patients improve their diet and exercise? Strongly Disagree	c. Work to help the patients improve their diet and exercise? Not applicable
d. Help smokers to quit?	d. Help smokers to quit? Strongly Agree	d. Help smokers to quit? Somewhat Agree	d. Help smokers to quit? Somewhat Disagree	d. Help smokers to quit? Strongly Disagree	d. Help smokers to quit? Not applicable