Cardio Oncology Survey Question Title * 1. How would you rate your knowledge of Cardio Oncology, cancer and heart disease Very Knowledgeable Above Average About Average Below Average No knowledge of cardio oncology Very Knowledgeable Above Average About Average Below Average No knowledge of cardio oncology Question Title * 2. How comfortable are you treating patients with cancer therapy related cardiac toxicities? Uncomfortable Somewhat uncomfortable Neither comfortable nor uncomfortable Somewhat comfortable Comfortable Uncomfortable Somewhat uncomfortable Neither comfortable nor uncomfortable Somewhat comfortable Comfortable Question Title * 3. Do you take care of cardio oncology patients in your practice? Yes No Question Title * 4. If yes: <10 % of my practice <30 % of my practice <50% of my practice > 50 % of my practice Question Title * 5. Are there dedicated cardio oncology services in your hospital/community? Yes No I don't know Question Title * 6. If yes, have you referred any patients to those services? Yes No Question Title * 7. What level of cooperation do you have with your local oncologists for co-management of cardiovascular complications of cancer treatment? (1-5) No cooperation Low cooperation No opinion Some cooperation Excellent Cooperation No cooperation Low cooperation No opinion Some cooperation Excellent Cooperation Question Title * 8. Are there local cardio oncology educational resources in your community? Check all that apply. Conferences Tumor boards Case presentation meetings Other (please specify) Question Title * 9. Do you find having cardio oncology services/practice in your community of value? Yes No Question Title * 10. What are the main barriers in establishing a cardio oncology program/practice in your community? Check all that apply. Lack of awareness Lack of mentoring Lack of interest Lack of financial resources Inadequate reimbursement Not considered important Political/employer referral bias Question Title * 11. How many educational programs in Cardio Oncology have you attended in the last 3-5 years? Question Title * 12. Which programs (if any) did you attend? Check all that apply. Global Cardio Oncology Summit ACC Cardio Oncology Memorial Sloan Kettering ACC or AHA Scientific Meeting cardio oncology session Other (please specify) Question Title * 13. Is there anything important that would concern cardio oncology in your community that we have not addressed? The following information will be used for demographic purposes only. Question Title * 14. What is your age? 30-39 40-49 50-59 60 or older Question Title * 15. What is your gender? Female Male Other (specify) Question Title * 16. Type of Practice Private Academic Hospital employed Single practitioner Specialty group Done
