Frankston and Neck Cancer GP Education Series
4th December 2019 5:30 till 9:00pm
Frankston Arts Centre
127 - 37 Davey Street
Frankston, 3199
Registration and short survey

Registration and optional survey for head and neck cancer education series

The Head and Neck Cancer GP Education Series is a new initiative that seeks to up skill and further develop GPs confidence to manage head and neck cancer and survivorship issues for their patients in general practice.

The optional survey consists of a brief (12 question) online survey to identify your current knowledge levels and prompts you to reflect on your individual learning needs in the area of head and neck cancer management.

Once you have completed all the required questions and have reached the end of the questionnaire please click the DONE button at the bottom of the page to save your response .

Expected duration: 10 mins.

Understanding GPs initial needs and interests for learning in the area of head and neck cancer will assist us to tailor the content of the education seminar to your individual learning needs. Survey responses will remain confidential.

Thank you for your time and assistance with this questionnaire and do not hesitate to contact me with questions or concerns.

Heather Davis Senior Project Manager
Southern Melbourne Integrated Cancer Service
Monash Health
Postal Address: PO Box 72, Bentleigh East VIC 3165
Ph: 03 9928 8101 | Fax: 03 9928 8624
heather.davis@monashhealth.org
www.smics.org.au

Question Title

* 1. Please complete and confirm your details below:

Name:

RACGP Number:

Name of Medical Practice:

Address:

Suburb:

Postcode:

Work phone:

Fax number:

Email address:

Mobile:

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* 2. Please list any special dietary requirements below:

Dietary Requirements

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* 3. Which GP organisation are you a member of?

South Eastern Melbourne Primary Health Network

Not a member

Other (please specify)

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* 4. Please prioritise which stages of the head and neck optimal care pathway you would most like to learn more about on a scale from 1-5.
(1= lowest need, 5= highest need)

	1	2	3	4	5
Prevention and early detection	Prevention and early detection 1	Prevention and early detection 2	Prevention and early detection 3	Prevention and early detection 4	Prevention and early detection 5
Presentation, initial investigations and referral	Presentation, initial investigations and referral 1	Presentation, initial investigations and referral 2	Presentation, initial investigations and referral 3	Presentation, initial investigations and referral 4	Presentation, initial investigations and referral 5
Diagnosis, staging and treatment planning	Diagnosis, staging and treatment planning 1	Diagnosis, staging and treatment planning 2	Diagnosis, staging and treatment planning 3	Diagnosis, staging and treatment planning 4	Diagnosis, staging and treatment planning 5
Treatment	Treatment 1	Treatment 2	Treatment 3	Treatment 4	Treatment 5
Care after initial treatment and recovery	Care after initial treatment and recovery 1	Care after initial treatment and recovery 2	Care after initial treatment and recovery 3	Care after initial treatment and recovery 4	Care after initial treatment and recovery 5
Managing recurrent, residual, or metastatic disease	Managing recurrent, residual, or metastatic disease 1	Managing recurrent, residual, or metastatic disease 2	Managing recurrent, residual, or metastatic disease 3	Managing recurrent, residual, or metastatic disease 4	Managing recurrent, residual, or metastatic disease 5
End-of-life care	End-of-life care 1	End-of-life care 2	End-of-life care 3	End-of-life care 4	End-of-life care 5

Other (please specify)

Question Title

* 5. Please prioritise your learning needs in the specified areas of head and neck cancer care/ management on a scale from 1-5? (1 = lowest need, 5= highest need)

	1	2	3	4	5
Referral pathways	Referral pathways 1	Referral pathways 2	Referral pathways 3	Referral pathways 4	Referral pathways 5
Biopsy techniques and when to use	Biopsy techniques and when to use 1	Biopsy techniques and when to use 2	Biopsy techniques and when to use 3	Biopsy techniques and when to use 4	Biopsy techniques and when to use 5
Pathology/ reporting	Pathology/ reporting 1	Pathology/ reporting 2	Pathology/ reporting 3	Pathology/ reporting 4	Pathology/ reporting 5
Providing a diagnosis	Providing a diagnosis 1	Providing a diagnosis 2	Providing a diagnosis 3	Providing a diagnosis 4	Providing a diagnosis 5
Counselling	Counselling 1	Counselling 2	Counselling 3	Counselling 4	Counselling 5
Understanding prognosis	Understanding prognosis 1	Understanding prognosis 2	Understanding prognosis 3	Understanding prognosis 4	Understanding prognosis 5
Survivorship	Survivorship 1	Survivorship 2	Survivorship 3	Survivorship 4	Survivorship 5

Other (please specify)

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* 6. Please indicate any specific or additional learnings that you hope to gain from your attendance at the Head and Neck GP Education Series?

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* 7. Please indicate if you/ or your place of work has a system/s in place for:

Patient education and information

Triage for urgent assessment and referral

Clear understanding of referral pathway

None of the above

Other (please specify)

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* 8. Consider your own practice in terms of your skill, confidence and knowledge with head and neck cancer diagnosis, referral and management. Please indicate your level of confidence.

very confident

confident

somewhat confident

not at all confident

not applicable

Other (please specify)

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* 9. Are you aware of the Head and Neck Optimal Care Pathway?
Please find weblink to guidelines below for your reference:
https://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-head-and-neck-cancers-june-2016.pdf

Yes

I am aware of the guidelines but do not refer to these in practice

I am interested to have this guideline information

Question Title

* 10. From the list below, please indicate the most significant barriers to being able manage head and neck cancer follow up and survivorship care in general practice (tick those that apply to you):

Managing a patient's side effects/ or long term effects related to treatment

Staying up to date with current information and guidelines

Accessing the treating specialist when required

Insufficient information in patient discharge and or treatment summaries

Timeliness of receipt of patient discharge and or treatment summaries

Lack of participation in Multidisciplinary team meeting discussions

Lack of throughput of head and neck cancer patients

Time pressures

Financial constraints for participation in care

Other (please specify)

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* 11. Which of the following strategies do you think would reduce the barriers for you to support head and neck cancer patients in general practice? Please choose the 3 strategies that are most likely to make a difference?

Patient treatment summary letter that specifically details the agents/ modalities of treatment, possible side effects and management plan for side effects

Contact details/ and access to treating cancer specialist when required

Clear referral pathways for head and neck cancer in the local area

Targetted education offered via a range of flexible learning approaches for GPs

Opportunity to participate in Multidisciplinary team meeting in virtual (webex) or teleconference approach with all care providers

Development of shared care follow up model for head and neck cancer survivors

Other (please specify)

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* 12. Is there anything else you would like to add?

Thank you for registering for the event and completing the survey.

We hope the Head and Neck Cancer Education Series meets your learning expectations.

Question Title

* 1. Please complete and confirm your details below:

Question Title

* 2. Please list any special dietary requirements below:

Question Title

* 3. Which GP organisation are you a member of?

Question Title

* 4. Please prioritise which stages of the head and neck optimal care pathway you would most like to learn more about on a scale from 1-5. (1= lowest need, 5= highest need)

Question Title

* 5. Please prioritise your learning needs in the specified areas of head and neck cancer care/ management on a scale from 1-5? (1 = lowest need, 5= highest need)

Question Title

* 6. Please indicate any specific or additional learnings that you hope to gain from your attendance at the Head and Neck GP Education Series?

Question Title

* 7. Please indicate if you/ or your place of work has a system/s in place for:

Question Title

* 8. Consider your own practice in terms of your skill, confidence and knowledge with head and neck cancer diagnosis, referral and management. Please indicate your level of confidence.

Question Title

* 9. Are you aware of the Head and Neck Optimal Care Pathway? Please find weblink to guidelines below for your reference:https://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-head-and-neck-cancers-june-2016.pdf

Question Title

* 10. From the list below, please indicate the most significant barriers to being able manage head and neck cancer follow up and survivorship care in general practice (tick those that apply to you):

Question Title

* 11. Which of the following strategies do you think would reduce the barriers for you to support head and neck cancer patients in general practice? Please choose the 3 strategies that are most likely to make a difference?

Question Title

* 12. Is there anything else you would like to add?

* 4. Please prioritise which stages of the head and neck optimal care pathway you would most like to learn more about on a scale from 1-5.
(1= lowest need, 5= highest need)

* 9. Are you aware of the Head and Neck Optimal Care Pathway?
Please find weblink to guidelines below for your reference:
https://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-head-and-neck-cancers-june-2016.pdf