Workshop Evaluation 2015

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* 1. I attended as a:

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* 2. Which race/ethnicity best describes you? (Please choose only one.)

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* 3. How old are you

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* 4. Are you male or female?

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* 5. What is the highest level of education you have completed?

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* 6. How knowledgeable were you about cancer treatment side effects BEFORE this workshop?

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* 7. How knowledgeable were you about cancer treatment side effects AFTER this workshop?

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* 8. As a result of this workshop:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel a greater sense of control over dealing with and managing side effects of cancer treatment
I understand that there are specific steps that can be taken to manage fatigue
I am confident I can ask my healthcare team questions about side effects of cancer and its treatment

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* 9. The social and emotional effects of cancer, and their impact on my life, have been adequately addressed by my healthcare team.

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* 10. I have experienced emotional distress due to my/ my loved one's cancer.

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* 11. As a result of this webinar, I feel better prepared to emotionally cope with this cancer experience.

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* 12. I would recommend this workshop to others with cancer and their loved ones.

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* 13. General comments or suggestions about the workshop (i.e. are there other topics not covered in this workshop that you would be interested in, etc.):

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* 14. Where do you seek information about cancer treatment? Check all that apply.

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* 15. Where do you turn for emotional support to deal with cancer? Check all that apply.

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* 16. Is this the first educational webinar you have participated in?

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* 17. Do you currently participate in a support group?

If you participated on the webinar as a spouse/partner, family member or friend please answer the following questions (cancer patient specific questions follow):

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* 18. How strongly do you identify with the caregiving role?

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* 19. Approximately how much time do you spend each week providing care to someone with cancer?

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* 20. How strongly are you involved in coordinating your loved one's care (i.e transportation, cooking, finances, administering medication, etc.)?

If you are a person with cancer/cancer survivor, please answer the remaining questions:

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* 21. What was your primary cancer diagnosis?

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* 22. Do you have metastatic/advanced cancer?

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* 23. How long has it been since you were first diagnosed with cancer?

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* 24. When you were first diagnosed, how involved were you in choosing a specific course or type of treatment?

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* 25. What kind of treatment have you received/are you currently receiving? Check all that apply

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* 26. When you were first diagnosed, how many treatment options did your healthcare team present you with?

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* 27. Please select the statement(s) below that BEST describe why you chose the treatment you did.

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* 28. Have you experienced any of the following side effects from treatment or the cancer itself? Check all that apply

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* 29. Optional: Please provide your name and contact information if you would like to be contacted about Gilda's Club programming or events.

Thank you for your feedback!

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