Your Experience Using "My Plan of Care" booklet Survey

We want to know if the "My Plan of Care" booklet you were given at your first consultation appointment was useful to you and your family. Hearing about your experience will help us to improve the usefulness of this booklet for you and other patients.

	Strongly agree	Agree	Disagree	Strongly disagree
It was easy to use.	It was easy to use. Strongly agree	It was easy to use. Agree	It was easy to use. Disagree	It was easy to use. Strongly disagree
It helped me to know what the next step in my care would be.	It helped me to know what the next step in my care would be. Strongly agree	It helped me to know what the next step in my care would be. Agree	It helped me to know what the next step in my care would be. Disagree	It helped me to know what the next step in my care would be. Strongly disagree
It helped me to feel less worried or anxious about what the next step in my care would be.	It helped me to feel less worried or anxious about what the next step in my care would be. Strongly agree	It helped me to feel less worried or anxious about what the next step in my care would be. Agree	It helped me to feel less worried or anxious about what the next step in my care would be. Disagree	It helped me to feel less worried or anxious about what the next step in my care would be. Strongly disagree
It helped me to know what will happen at my appointments.	It helped me to know what will happen at my appointments. Strongly agree	It helped me to know what will happen at my appointments. Agree	It helped me to know what will happen at my appointments. Disagree	It helped me to know what will happen at my appointments. Strongly disagree
It helped me to keep track of the contact information for members of my healthcare team.	It helped me to keep track of the contact information for members of my healthcare team. Strongly agree	It helped me to keep track of the contact information for members of my healthcare team. Agree	It helped me to keep track of the contact information for members of my healthcare team. Disagree	It helped me to keep track of the contact information for members of my healthcare team. Strongly disagree
It helped me to keep track of my side effects.	It helped me to keep track of my side effects. Strongly agree	It helped me to keep track of my side effects. Agree	It helped me to keep track of my side effects. Disagree	It helped me to keep track of my side effects. Strongly disagree
It helped me to talk about my side effects with members of my healthcare team.	It helped me to talk about my side effects with members of my healthcare team. Strongly agree	It helped me to talk about my side effects with members of my healthcare team. Agree	It helped me to talk about my side effects with members of my healthcare team. Disagree	It helped me to talk about my side effects with members of my healthcare team. Strongly disagree
It helped me to keep track of the tests I had.	It helped me to keep track of the tests I had. Strongly agree	It helped me to keep track of the tests I had. Agree	It helped me to keep track of the tests I had. Disagree	It helped me to keep track of the tests I had. Strongly disagree
It helped me to talk about my questions with members of my healthcare team.	It helped me to talk about my questions with members of my healthcare team. Strongly agree	It helped me to talk about my questions with members of my healthcare team. Agree	It helped me to talk about my questions with members of my healthcare team. Disagree	It helped me to talk about my questions with members of my healthcare team. Strongly disagree
It helped me to keep track of my treatment plan.	It helped me to keep track of my treatment plan. Strongly agree	It helped me to keep track of my treatment plan. Agree	It helped me to keep track of my treatment plan. Disagree	It helped me to keep track of my treatment plan. Strongly disagree
It helped me to keep track of changes to my treatment plan.	It helped me to keep track of changes to my treatment plan. Strongly agree	It helped me to keep track of changes to my treatment plan. Agree	It helped me to keep track of changes to my treatment plan. Disagree	It helped me to keep track of changes to my treatment plan. Strongly disagree
It helped me to share my treatment plan with my family physician or other members of my healthcare team.	It helped me to share my treatment plan with my family physician or other members of my healthcare team. Strongly agree	It helped me to share my treatment plan with my family physician or other members of my healthcare team. Agree	It helped me to share my treatment plan with my family physician or other members of my healthcare team. Disagree	It helped me to share my treatment plan with my family physician or other members of my healthcare team. Strongly disagree

Strongly agree

Agree

Disagree

Strongly disagree

It was easy to use.

It was easy to use. Strongly agree

It was easy to use. Agree

It was easy to use. Disagree

It was easy to use. Strongly disagree

It helped me to know what the next step in my care would be.

It helped me to know what the next step in my care would be. Strongly agree

It helped me to know what the next step in my care would be. Agree

It helped me to know what the next step in my care would be. Disagree

It helped me to know what the next step in my care would be. Strongly disagree

It helped me to feel less worried or anxious about what the next step in my care would be.

It helped me to feel less worried or anxious about what the next step in my care would be. Strongly agree

It helped me to feel less worried or anxious about what the next step in my care would be. Agree

It helped me to feel less worried or anxious about what the next step in my care would be. Disagree

It helped me to feel less worried or anxious about what the next step in my care would be. Strongly disagree

It helped me to know what will happen at my appointments.

It helped me to know what will happen at my appointments. Strongly agree

It helped me to know what will happen at my appointments. Agree

It helped me to know what will happen at my appointments. Disagree

It helped me to know what will happen at my appointments. Strongly disagree

It helped me to keep track of the contact information for members of my healthcare team.

It helped me to keep track of the contact information for members of my healthcare team. Strongly agree

It helped me to keep track of the contact information for members of my healthcare team. Agree

It helped me to keep track of the contact information for members of my healthcare team. Disagree

It helped me to keep track of the contact information for members of my healthcare team. Strongly disagree

It helped me to keep track of my side effects.

It helped me to keep track of my side effects. Strongly agree

It helped me to keep track of my side effects. Agree

It helped me to keep track of my side effects. Disagree

It helped me to keep track of my side effects. Strongly disagree

It helped me to talk about my side effects with members of my healthcare team.

It helped me to talk about my side effects with members of my healthcare team. Strongly agree

It helped me to talk about my side effects with members of my healthcare team. Agree

It helped me to talk about my side effects with members of my healthcare team. Disagree

It helped me to talk about my side effects with members of my healthcare team. Strongly disagree

It helped me to keep track of the tests I had.

It helped me to keep track of the tests I had. Strongly agree

It helped me to keep track of the tests I had. Agree

It helped me to keep track of the tests I had. Disagree

It helped me to keep track of the tests I had. Strongly disagree

It helped me to talk about my questions with members of my healthcare team.

It helped me to talk about my questions with members of my healthcare team. Strongly agree

It helped me to talk about my questions with members of my healthcare team. Agree

It helped me to talk about my questions with members of my healthcare team. Disagree

It helped me to talk about my questions with members of my healthcare team. Strongly disagree

It helped me to keep track of my treatment plan.

It helped me to keep track of my treatment plan. Strongly agree

It helped me to keep track of my treatment plan. Agree

It helped me to keep track of my treatment plan. Disagree

It helped me to keep track of my treatment plan. Strongly disagree

It helped me to keep track of changes to my treatment plan.

It helped me to keep track of changes to my treatment plan. Strongly agree

It helped me to keep track of changes to my treatment plan. Agree

It helped me to keep track of changes to my treatment plan. Disagree

It helped me to keep track of changes to my treatment plan. Strongly disagree

It helped me to share my treatment plan with my family physician or other members of my healthcare team.

It helped me to share my treatment plan with my family physician or other members of my healthcare team. Strongly agree

It helped me to share my treatment plan with my family physician or other members of my healthcare team. Agree

It helped me to share my treatment plan with my family physician or other members of my healthcare team. Disagree

It helped me to share my treatment plan with my family physician or other members of my healthcare team. Strongly disagree

Your Experience Using "My Plan of Care" booklet

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* 1. Please tell us about yourself. I am a:

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* 2. What type of cancer are you being treated for? Please select all that apply to you.

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* 3. Please choose the answer that tells us about your experience using the "My Plan of Care" booklet.

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* 4. Do you have any suggestions for how the "My Plan of Care" booklet could be improved?