Thrombosis Canada National Needs Assessment

We are conducting this survey to help identify your learning needs in thrombosis. Your answers will help us to design new educational programs and materials – thank you!

Question Title

1. Please indicate your area of healthcare practice: (Required.)

Nurse / Nurse Practitioner

Pharmacist

Physician

Pharmaceutical company

Other (please specify)

Question Title

2. Please indicate your medical specialty, if applicable: (Required.)

Hematology

Medical Oncology

Cardiology

Emergency Medicine

Primary Care/Family Practice

General Internal Medicine

Not applicable

Other (please specify)

Question Title

3. Which of the following best describes your clinical practice setting? Choose all that apply. (Required.)

University-affiliated/academic hospital

Community-based hospital

Community-based clinic

Other (please specify)

Question Title

4. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is most affected by a practice gap? Please select the option that you believe is of HIGHEST priority. (Required.)

Anticoagulant interactions with other medications

Cancer-associated thrombosis

Anticoagulants and bleeding

Management of DVT/PE

Diagnosis of DVT/PE

Prevention of DVT/PE

Periprocedural management of anticoagulation

Thrombosis management in special populations (renal failure, obesity, thrombophilia, etc.)

Anticoagulation in atrial fibrillation

Thrombosis in women

Thrombosis management in the emergency department

Pediatric thrombosis

Other (please specify)

Question Title

5. For your priority from the previous question, why do you believe there is a practice gap? (Required.)

Knowledge gap (awareness of, or access to, most updated evidence and guidance)

Performance gap (having skills or resources to implement knowledge to practice)

Please expand on your answer:

Question Title

6. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is the second-most affected by a practice gap? Please select the option that you believe is of SECOND-HIGHEST priority. (Required.)

Prevention of DVT/PE

Thrombosis management in the emergency department

Anticoagulant interactions with other medications

Management of DVT/PE

Thrombosis in women

Anticoagulants and bleeding

Cancer-associated thrombosis

Diagnosis of DVT/PE

Thrombosis management in special populations (renal failure, obesity, thrombophilia, etc.)

Anticoagulation in atrial fibrillation

Periprocedural management of anticoagulation

Pediatric thrombosis

Other (please specify)

Question Title

7. For your second choice, why do you believe there is a practice gap? (Required.)

Knowledge gap (awareness of, or access to, most updated evidence and guidance)

Performance gap (having skills or resources to implement knowledge to practice)

Please expand on your answer:

Question Title

8. List up to 3 topics in thrombosis that you would most like to see covered in future Thrombosis Canada CME activities? (Required.)

Question Title

9. Which of the following skills or procedures related to thrombosis would you like to see addressed in Thrombosis Canada CME educational activities? Please check all that apply. (Required.)

Communicating thrombosis risk to patients

Discussing hereditary thrombophilia testing with patients

Communicating bleeding risk to patients

Navigating issues related to drug access

Setting up a practice audit in your clinic or hospital

Implementing antithrombotic or bleeding management protocols in your clinical setting

Other (please specify)

Question Title

10. How frequently do you visit the Thrombosis Canada Website (thrombosiscsanada.ca)? (Required.)

Several times per week

Weekly

Monthly

Less than monthly

Didn't know it existed

Question Title

11. Please complete the following if you wish to receive a discount on our annual conference registration:

Name

e-mail address

City

Province

Thrombosis Canada National Needs Assessment

Question Title

* 1. Please indicate your area of healthcare practice: (Required.)

Question Title

* 2. Please indicate your medical specialty, if applicable: (Required.)

Question Title

* 3. Which of the following best describes your clinical practice setting? Choose all that apply. (Required.)

Question Title

* 4. A “practice gap” occurs when there is a difference between actual and ideal performance.Which of the following subject areas in thrombosis do you believe is most affected by a practice gap? Please select the option that you believe is of HIGHEST priority. (Required.)

Question Title

* 5. For your priority from the previous question, why do you believe there is a practice gap? (Required.)

Question Title

* 6. A “practice gap” occurs when there is a difference between actual and ideal performance.Which of the following subject areas in thrombosis do you believe is the second-most affected by a practice gap? Please select the option that you believe is of SECOND-HIGHEST priority. (Required.)

Question Title

* 7. For your second choice, why do you believe there is a practice gap? (Required.)

Question Title

* 8. List up to 3 topics in thrombosis that you would most like to see covered in future Thrombosis Canada CME activities? (Required.)

Question Title

* 9. Which of the following skills or procedures related to thrombosis would you like to see addressed in Thrombosis Canada CME educational activities? Please check all that apply. (Required.)

Question Title

* 10. How frequently do you visit the Thrombosis Canada Website (thrombosiscsanada.ca)? (Required.)

Question Title

* 11. Please complete the following if you wish to receive a discount on our annual conference registration:

1. Please indicate your area of healthcare practice: (Required.)

2. Please indicate your medical specialty, if applicable: (Required.)

3. Which of the following best describes your clinical practice setting? Choose all that apply. (Required.)

4. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is most affected by a practice gap? Please select the option that you believe is of HIGHEST priority. (Required.)

5. For your priority from the previous question, why do you believe there is a practice gap? (Required.)

6. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is the second-most affected by a practice gap? Please select the option that you believe is of SECOND-HIGHEST priority. (Required.)

7. For your second choice, why do you believe there is a practice gap? (Required.)

8. List up to 3 topics in thrombosis that you would most like to see covered in future Thrombosis Canada CME activities? (Required.)

9. Which of the following skills or procedures related to thrombosis would you like to see addressed in Thrombosis Canada CME educational activities? Please check all that apply. (Required.)

10. How frequently do you visit the Thrombosis Canada Website (thrombosiscsanada.ca)? (Required.)

11. Please complete the following if you wish to receive a discount on our annual conference registration: