The Northwest Tribal Comprehensive Cancer Program appreciates your responses.
Your feedback is invaluable in guiding our work to support cancer-free Tribal communities.
Your answers are anonymous.

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* 1. Where do you work?

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* 3. What is your role in cancer prevention and control within your community/clinic?

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* 4. If a patient has an abnormal cancer screening result, what step do you usually take next?

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* 5. What cancer treatment center do you refer cancer patients to?

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* 6. What are the most common cancers that you see in your practice? Please select the top 3

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* 7. How do you receive information about the care a patient referred for cancer treatment receives? (select all that apply)

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* 8. How do you promote cancer screenings in your clinic? (select all that apply)

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* 9. Please rank the resources our program can provide for increasing cancer screening in your patients from most helpful to least helpful

  Not at all helpful Somewhat helpful Moderately helpful Very helpful Extremely helpful
Technical assistance and training on cancer interventions that work
Data that describes the burden of cancer
Bringing people together to talk about how we can decrease the burden of cancer
Providing seed money to implement interventions in the cancer plan
Ensuring that we have an up-to-date and comprehensive cancer plan
Providing resources like cancer ads and posters
Providing cancer training with CMEs
Survivorship care visit checklist

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* 10. To what extent are you familiar with the following community resources that support survivorship initiatives?

  Not at all familiar Somewhat familiar Moderately familiar Very familiar Completely familiar
Cancer survivor support group
Tobacco cessation program
CHW or patient navigators that help cancer survivors navigate
Nutrition and physical activity information for survivors

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* 11. What do you think is needed the most to support cancer survivors in your community?

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* 12. Are EHR records being used to populate some of the data needed for cancer survivor care plans?

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* 13. If your clinic has a patient navigator: What type of training do you think your patient navigator(s) could benefit from?

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* 14. To what extent are you satisfied with the care that your patients with cancer receive?

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* 15. Please feel free to provide additional information here:

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