This survey is about your service and provision of cancer rehabilitation program.

Taking part in this survey is voluntary. Your responses are confidential. They will be combined with the responses of others in reports.

Completing this survey:

For most questions, there is a choice of answers. Pick the response/s that suit best for you.

There are areas throughout the survey for you to make comments about your program and the health care aspects that your service provides.

The survey may take 15 minutes to complete.

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* 1. Today's Date

Date

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* 2. Name

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* 3. What is your gender?

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* 4. What is your age range?

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* 5. State/Territory/Other

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* 6. What is your current position?

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* 7. Qualification Details

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* 8. Organisation details

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* 9. Contact details

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* 10. Which of the following areas do you currently work in?

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* 11. Has your formal fellowship training prepared you to meet the rehabilitation needs of cancer patients?

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* 12. Do you look after cancer patients? If no, please tick No and proceed to end of survey.

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* 13. How many years have you been looking after cancer patients?

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* 14. Have you had any of the following components as part of your cancer rehabilitation training? If yes, please tick relevant box(es).

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* 15. Do you work in a dedicated cancer rehabilitation program?

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* 16. What is the funding source for your cancer rehabilitation program?

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* 17. With your cancer rehabilitation program, how long has this been established for? 

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* 18. Who leads your cancer rehabilitation program?

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* 19. Who is involved in your multidisciplinary team in your cancer rehabilitation program? Please tick all relevant boxes.

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* 20. Which of the following tumour stream(s) are commonly referred to your cancer rehabilitation program? Please tick all relevant boxes.

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* 21. At what phase in a patient's cancer trajectory are cancer patients referred to your program? Please tick all relevant boxes.

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* 22. Who usually refers the patient to your cancer rehabilitation program? Please tick all relevant boxes.

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* 23. Medical Evaluation/Management

Please tick all relevant core component(s) IF this is provided by your cancer rehabilitation program:

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* 24. Patient Education

Please tick relevant core component(s) IF this is provided by your cancer rehabilitation program

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* 25. Exercise prescription/use of modalities

Please tick all relevant core component(s) IF this is provided by your cancer rehabilitation program:

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* 26. Specialised/other interventions

Please tick all relevant core component(s) IF this is provided by your cancer rehabilitation program:

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* 27. Do you evaluate any of the following outcomes at the end of your cancer rehabilitation program? If yes, please tick relevant box(es).

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* 28. Does your cancer rehabilitation program provide specialised care for patients with advanced cancer or those requiring end-of-life care (e.g. advance care planning, symptom management)?

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* 29. Are you satisfied with the cancer rehabilitation program that your service currently provides?

Dissatisfied Neutral Very satisfied
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i We adjusted the number you entered based on the slider’s scale.

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* 30. Please list 5 barriers that you think limit your organisation's ability to provide a comprehensive cancer rehabilitation program.

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* 31. Please list 5 facilitators to successful implementation of your cancer rehabilitation program.

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* 32.
Thank you for filling out the survey.

If you have any comments regarding the questionnaire or queries, please use the following box below to do so.

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