The effects of chemotherapy for breast cancer on managing daily tasks

This questionnaire should take approximately 30 minutes to complete.

Please answer the questionnaire as honestly and accurately as possible. All responses will be kept strictly confidential and anonymous. There is a blank page at the end of the questionnaire should you wish to add anything about your experiences of managing daily activities.

If you have questions or comments please contact the researcher: Catherine Lawrence at Loughborough University
Tel: 01509 228151 or Email: C.L.Lawrence@lboro.ac.uk

Thank you for taking the time to complete the questionnaire. We value your thoughts and experiences.

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1. Please enter your email address so that you can be sent a link to the next questionnaire in 4 months time

Please enter your email address so that you can be sent a link to the next questionnaire in 4 months time

2. Please complete the following

	Yes	No
I have read the Participant Information Sheet dated 27/05/2009 (Version 1) and have had the opportunity to consider the information. Any questions I had have been answered satisfactorily.	*Please complete the following I have read the Participant Information Sheet dated 27/05/2009 (Version 1) and have had the opportunity to consider the information. Any questions I had have been answered satisfactorily. Yes	I have read the Participant Information Sheet dated 27/05/2009 (Version 1) and have had the opportunity to consider the information. Any questions I had have been answered satisfactorily. No
I understand that my participation is voluntary and that I am free to withdraw from the study at any time and do not need to give a reason.	I understand that my participation is voluntary and that I am free to withdraw from the study at any time and do not need to give a reason. Yes	I understand that my participation is voluntary and that I am free to withdraw from the study at any time and do not need to give a reason. No
I agree to being contacted by the researcher if necessary.	I agree to being contacted by the researcher if necessary. Yes	I agree to being contacted by the researcher if necessary. No
I understand that the information I provide will be kept strictly confidential to the research team at Loughborough University, in accordance with the Data Protection Act.	I understand that the information I provide will be kept strictly confidential to the research team at Loughborough University, in accordance with the Data Protection Act. Yes	I understand that the information I provide will be kept strictly confidential to the research team at Loughborough University, in accordance with the Data Protection Act. No
I understand that only anonymous data may be published.	I understand that only anonymous data may be published. Yes	I understand that only anonymous data may be published. No
I agree to take part in the questionnaire study.	I agree to take part in the questionnaire study. Yes	I agree to take part in the questionnaire study. No
Do you wish to keep a diary?	Do you wish to keep a diary? Yes	Do you wish to keep a diary? No
If YES, I understand that anonymous quotations may be published.	If YES, I understand that anonymous quotations may be published. Yes	If YES, I understand that anonymous quotations may be published. No

Please type your name which will be taken as signed consent to take part in the study

The effects of chemotherapy for breast cancer on managing daily tasks - Time 1

1. Introduction and Consent

*
1. Please enter your email address so that you can be sent a link to the next questionnaire in 4 months time

2. Please complete the following

The effects of chemotherapy for breast cancer on managing daily tasks - Time 1

1. Introduction and Consent

*1. Please enter your email address so that you can be sent a link to the next questionnaire in 4 months time

2. Please complete the following

*
1. Please enter your email address so that you can be sent a link to the next questionnaire in 4 months time