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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!
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1.
Please indicate your area of healthcare practice:
(Required.)
Nurse / Nurse Practitioner
Pharmacist
Physician
Pharmaceutical company
Other (please specify)
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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)
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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)
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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.)
Thrombosis in women
Management of DVT/PE
Periprocedural management of anticoagulation
Prevention of DVT/PE
Thrombosis management in the emergency department
Anticoagulants and bleeding
Cancer-associated thrombosis
Diagnosis of DVT/PE
Anticoagulant interactions with other medications
Anticoagulation in atrial fibrillation
Thrombosis management in special populations (renal failure, obesity, thrombophilia, etc.)
Pediatric thrombosis
Other (please specify)
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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:
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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.)
Anticoagulation in atrial fibrillation
Cancer-associated thrombosis
Thrombosis management in special populations (renal failure, obesity, thrombophilia, etc.)
Diagnosis of DVT/PE
Thrombosis in women
Anticoagulants and bleeding
Periprocedural management of anticoagulation
Management of DVT/PE
Prevention of DVT/PE
Anticoagulant interactions with other medications
Thrombosis management in the emergency department
Pediatric thrombosis
Other (please specify)
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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:
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8.
List up to 3 topics in thrombosis that you would most like to see covered in future Thrombosis Canada CME activities?
(Required.)
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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
Setting up a practice audit in your clinic or hospital
Navigating issues related to drug access
Communicating bleeding risk to patients
Implementing antithrombotic or bleeding management protocols in your clinical setting
Other (please specify)
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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
11.
Please complete the following if you wish to receive a discount on our annual conference registration:
Name
e-mail address
City
Province
