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Living Now Newsletter
3.
Please take a moment to give us your feedback
Please answer the following questions about the post-transplant newsletter Living Now. We need your feedback to make our materials as helpful as possible.
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1.
Who reads your Living Now newsletters? (Check all that apply)
(Required.)
Patient
Caregiver
Family
Friends
No one
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2.
Do you save the newsletters to read again?
(Required.)
Yes
No
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3.
Would you read Living Now online?
(Required.)
Yes
No
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4.
As you consider the Living Now newsletters you have received, how useful were the following topics and features:
(Required.)
Very useful
Useful
Not useful
Did not read
Health concerns (e.g., signs of infection or GVHD)
Very useful
Useful
Not useful
Did not read
Emotional concerns (e.g., depression, coping styles)
Very useful
Useful
Not useful
Did not read
Medication information
Very useful
Useful
Not useful
Did not read
Lifestyle choices (e.g., diet, relaxation techniques)
Very useful
Useful
Not useful
Did not read
Personal relationships
Very useful
Useful
Not useful
Did not read
Caregiving
Very useful
Useful
Not useful
Did not read
Post-transplant resources
Very useful
Useful
Not useful
Did not read
Patient photos and quotes
Very useful
Useful
Not useful
Did not read
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5.
Do the newsletters help you have better conversations with your medical team?
(Required.)
Yes
Not sure
No
Not applicable
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6.
Would you recommend Living Now to others in your situation?
(Required.)
Yes
Not sure
No
Other (please specify)
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7.
Would you recommend the Office of Patient Advocacy to others in your situation?
(Required.)
Yes
Not sure
No
Other (please specify)
For the following questions, please tell us about yourself. The information provided helps us understand your needs. All answers are confidential.
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8.
Patient is:
(Required.)
Male
Female
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9.
Patient’s age:
(Required.)
0–17 years
18–30 years
31 to 50 years
51 years and older
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10.
Patient’s ethnicity:
(Required.)
Hispanic or Latino
Not Hispanic or Latino
Decline to answer
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11.
Patient’s race (Check all that apply):
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Decline to answer
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12.
Patient’s highest level of education:
(Required.)
High School diploma
Associate degree
Undergraduate or Bachelor degree
Graduate or Doctoral degree
13.
Additional comments or suggestions (e.g., other survivorship topics of interest):
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14.
Would you be interested in receiving results of the Living Now survey?
(Required.)
Yes, via e-mail. (Provide your email address below.)
Yes, via U.S. mail. (Provide your full mailing address below.)
No
15.
Are you interested in sharing your post-transplant experience with other patients and families?
No, not at this time.
Yes, please send me the transplant journey questionnaire. (Provide contact information below.)
Your contact information, including full mailing address, phone number and email address: