Parenting a Child with Cancer Survey Attention parents of current and former child cancer patients: We need your help to identify unmet needs of families navigating the tumultuous journey of diagnosis and treatments. Please take a moment to participate in this anonymous survey. Estimated time of completion: 10 minutes. We thank you in advance for your time. If you have any questions please contact Helen Angaine at Group: helen@groupi-i.com P: 908.258.0043 Question Title * 1. At what age was your son or daughter diagnosed with cancer? Less than 3 years old 3 - 8 years old 9 - 14 years old 15+ years old Question Title * 2. Do you or did you ever feel inadequate and unsure of your ability to care of your sick child? Yes No I prefer not to answer Question Title * 3. If you answered yes to Question 2, will you or did you seek professional help for advice/ support on parenting a child with cancer? Yes No Does not apply Question Title * 4. Please indicate whether you used any of the following as an information source for parenting advice? (Select all that apply) Oncologist / Hematologist Primary Care Physician Oncology / Hematology Nurse Social Worker / Child Care Specialist Other health professional Family and Friends Parent Support Group Cancer organization websites Not needed Question Title * 5. Please rate the helpfulness of the parenting advice provided by the following information sources: Very Helpful Helpful Neutral Not Helpful Not offered Oncologist / Hematologist Oncologist / Hematologist Very Helpful Oncologist / Hematologist Helpful Oncologist / Hematologist Neutral Oncologist / Hematologist Not Helpful Oncologist / Hematologist Not offered Primary Care Physician Primary Care Physician Very Helpful Primary Care Physician Helpful Primary Care Physician Neutral Primary Care Physician Not Helpful Primary Care Physician Not offered Oncology / Hematology Nurse Oncology / Hematology Nurse Very Helpful Oncology / Hematology Nurse Helpful Oncology / Hematology Nurse Neutral Oncology / Hematology Nurse Not Helpful Oncology / Hematology Nurse Not offered Social Worker / Child Care Specialist Social Worker / Child Care Specialist Very Helpful Social Worker / Child Care Specialist Helpful Social Worker / Child Care Specialist Neutral Social Worker / Child Care Specialist Not Helpful Social Worker / Child Care Specialist Not offered Other health professional Other health professional Very Helpful Other health professional Helpful Other health professional Neutral Other health professional Not Helpful Other health professional Not offered Parent Support Group Parent Support Group Very Helpful Parent Support Group Helpful Parent Support Group Neutral Parent Support Group Not Helpful Parent Support Group Not offered Family and Friends Family and Friends Very Helpful Family and Friends Helpful Family and Friends Neutral Family and Friends Not Helpful Family and Friends Not offered Cancer organization websites Cancer organization websites Very Helpful Cancer organization websites Helpful Cancer organization websites Neutral Cancer organization websites Not Helpful Cancer organization websites Not offered Question Title * 6. Please indicate whether you agree with the following statements: Agree Disagree Not sure Parents who are well informed about their child's illness and treatment work more effectively with the hospital staff than do parents who are less informed. Parents who are well informed about their child's illness and treatment work more effectively with the hospital staff than do parents who are less informed. Agree Parents who are well informed about their child's illness and treatment work more effectively with the hospital staff than do parents who are less informed. Disagree Parents who are well informed about their child's illness and treatment work more effectively with the hospital staff than do parents who are less informed. Not sure Well-informed parents can help their children manage their illness more effectively than parents with less knowledge about childhood cancer and blood disorders Well-informed parents can help their children manage their illness more effectively than parents with less knowledge about childhood cancer and blood disorders Agree Well-informed parents can help their children manage their illness more effectively than parents with less knowledge about childhood cancer and blood disorders Disagree Well-informed parents can help their children manage their illness more effectively than parents with less knowledge about childhood cancer and blood disorders Not sure Well-informed parents can be a source of information and emotional support for other parents. Well-informed parents can be a source of information and emotional support for other parents. Agree Well-informed parents can be a source of information and emotional support for other parents. Disagree Well-informed parents can be a source of information and emotional support for other parents. Not sure Question Title * 7. Do/Did you receive emotional support from any of the following? (Please choose all that apply) Yes No Oncologist Oncologist Yes Oncologist No Primary Care Physician Primary Care Physician Yes Primary Care Physician No Oncology Nurse Oncology Nurse Yes Oncology Nurse No Social Worker Social Worker Yes Social Worker No Psychiatrist/Psychologist Psychiatrist/Psychologist Yes Psychiatrist/Psychologist No Spouse/Partner Spouse/Partner Yes Spouse/Partner No Family/Friends Family/Friends Yes Family/Friends No Religious/Spiritual Leader Religious/Spiritual Leader Yes Religious/Spiritual Leader No Parents of children w/ cancer Parents of children w/ cancer Yes Parents of children w/ cancer No Question Title * 8. Did the hospital or clinic where your child received care offer psycho-social support services for parents? Yes No Don't know Question Title * 9. If you answered yes to Question 8, did you use the psycho-social services? Yes No Prefer not to answer Question Title * 10. Please indicate whether you have ever received any of the following resources: Have used Have not used, but would like to Have not used, and have not needed Prefer not to answer Information on cancer and its treatment Information on cancer and its treatment Have used Information on cancer and its treatment Have not used, but would like to Information on cancer and its treatment Have not used, and have not needed Information on cancer and its treatment Prefer not to answer Parent support groups Parent support groups Have used Parent support groups Have not used, but would like to Parent support groups Have not used, and have not needed Parent support groups Prefer not to answer Psychological counseling services Psychological counseling services Have used Psychological counseling services Have not used, but would like to Psychological counseling services Have not used, and have not needed Psychological counseling services Prefer not to answer Question Title * 11. Please specify your gender. Female Male Prefer not to answer Question Title * 12. Please specify your age Younger than 25 25 - 34 35 - 44 45 - 54 55 or older Prefer not to answer Question Title * 13. Please specify your current marital status. Married / Living with Partner Separated / Divorced Never Married Prefer not to answer Question Title * 14. Please specify which of the following ranges includes your household income. Less than 25,000 25,000 - 49,999 50,000 - 75,000 More than 75,000 Prefer not to answer Question Title * 15. Please specify your highest degree or education level completed. Some high school High School Some College College Graduate School Prefer not to answer Thanks for sharing your opinions and personal experiences. If you have any question please contact Helen Angaine at Group i&i: helen@groupi-i.com P:908.258.0043. Done