Increasing Access: Utilizing a Collaborative Care Model to
Implement Palliative Care and Psychosocial Service in a Community Oncology Setting

Program Evaluation

We appreciate your participation in this continuing education activity. Your responses to our survey will allow us to improve our program offerings and services.

Thank you for your time!

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* What is your primary professional discipline?

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* What amount of time did you spend in today's activity:

EVALUATION OF TRAINING

For each statement provided below, please select the circle that best reflects your opinions about today’s session. Scale: 1= Strongly Disagree 2= Disagree 3=Neutral 4= Agree 5= Strongly Agree

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* I feel that as a result of this activity I will be better able to:

	Strongly DISAGREE	Disagree	Neutral	Agree	Strongly AGREE
Compare models of palliative care in the outpatient setting.	Compare models of palliative care in the outpatient setting. Strongly DISAGREE	Compare models of palliative care in the outpatient setting. Disagree	Compare models of palliative care in the outpatient setting. Neutral	Compare models of palliative care in the outpatient setting. Agree	Compare models of palliative care in the outpatient setting. Strongly AGREE
Describe a novel model for integrating supportive oncology care in a community setting.	Describe a novel model for integrating supportive oncology care in a community setting. Strongly DISAGREE	Describe a novel model for integrating supportive oncology care in a community setting. Disagree	Describe a novel model for integrating supportive oncology care in a community setting. Neutral	Describe a novel model for integrating supportive oncology care in a community setting. Agree	Describe a novel model for integrating supportive oncology care in a community setting. Strongly AGREE
Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services.	Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services. Strongly DISAGREE	Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services. Disagree	Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services. Neutral	Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services. Agree	Discuss process and outcome metrics associated with implementing community-based psychosocial and palliative care services. Strongly AGREE

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* In assessing this session, I believe:

	Strongly DISAGREE	Disagree	NEUTRAL	Agree	Strongly AGREE
There was enough time to cover the topic	There was enough time to cover the topic Strongly DISAGREE	There was enough time to cover the topic Disagree	There was enough time to cover the topic NEUTRAL	There was enough time to cover the topic Agree	There was enough time to cover the topic Strongly AGREE
I would recommend this session to my peers	I would recommend this session to my peers Strongly DISAGREE	I would recommend this session to my peers Disagree	I would recommend this session to my peers NEUTRAL	I would recommend this session to my peers Agree	I would recommend this session to my peers Strongly AGREE
The information was applicable to my daily activities	The information was applicable to my daily activities Strongly DISAGREE	The information was applicable to my daily activities Disagree	The information was applicable to my daily activities NEUTRAL	The information was applicable to my daily activities Agree	The information was applicable to my daily activities Strongly AGREE

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* Please rate the effectiveness of the presenter:
Consider presentation style, knowledge of subject, effectiveness in your assessment

	Completely INEFFECTIVE	Ineffective	Neutral	Effective	Highly EFFECTIVE
Hilary McGuire	Hilary McGuire Completely INEFFECTIVE	Hilary McGuire Ineffective	Hilary McGuire Neutral	Hilary McGuire Effective	Hilary McGuire Highly EFFECTIVE
Kate Lally	Kate Lally Completely INEFFECTIVE	Kate Lally Ineffective	Kate Lally Neutral	Kate Lally Effective	Kate Lally Highly EFFECTIVE

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* Was today’s topic one that you would have identified as important to you?

Yes

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* Describe the major strength(s) of today’s session.

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* Describe any perceived commercial bias.

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* Please share any additional comments and suggestions. Your feedback is extremely valuable to us.

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* Please indicate which certificate you are requesting:

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* Please list your information below so we may send you a Certificate:

Name/credentials

Company

State

Email Address

Question Title

* What is your primary professional discipline?

Question Title

* What amount of time did you spend in today's activity:

Question Title

* I feel that as a result of this activity I will be better able to:

Question Title

* In assessing this session, I believe:

Question Title

* Please rate the effectiveness of the presenter:Consider presentation style, knowledge of subject, effectiveness in your assessment

Question Title

* Was today’s topic one that you would have identified as important to you?

Question Title

* Describe the major strength(s) of today’s session.

Question Title

* Describe any perceived commercial bias.

Question Title

* Please share any additional comments and suggestions. Your feedback is extremely valuable to us.

Question Title

* Please indicate which certificate you are requesting:

Question Title

* Please list your information below so we may send you a Certificate:

* Please rate the effectiveness of the presenter:
Consider presentation style, knowledge of subject, effectiveness in your assessment