* 1. Unique Identifier:
Please enter your six-digit passcode, as used on the pre-test.

* 2. Demographics:

Gender

* 3. Demographics:

Age

* 4. Demographics:

Provider Type

* 5. Demographics:

Years in Practice

* 6. I need to learn more about colon cancer screening.

* 7. I feel comfortable discussing colon cancer screening with my patients.

* 8. I have time to discuss colon cancer screening with my patients.

* 9. I am knowledgeable about the recommended guidelines on colon cancer screening.

* 10. I believe that a digital rectal exam with stool hemoccult done in the office is helpful in colon cancer screening.

* 11. I believe that annual stool FIT test is helpful in colon cancer screening.

* 12. I believe that a colonoscopy every 10 years is helpful in colon cancer screening.

* 13. A stool FIT will find up to what percentage of colon cancers?

* 14. In the future, when recommending colon cancer screening, I plan to discuss multiple options with my patients.

* 15. In the future, which colon cancer screening options will you discuss with your patients? CHECK ALL THAT APPLY.

* 16. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Annual Rectal Exam with office stool hemoccults

* 17. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Annual Stool Guaiac Test x 3 for hemoccult

* 18. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Annual Stool FIT test

* 19. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Colonoscopy every 10 years

* 20. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Flexible Sigmoidoscopy every 3 – 5 years

* 21. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Air Contrast Barium Enema

* 22. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Virtual Colonoscopy

* 23. In the future, when referring patients for colon cancer screenings, what percentage of the time do you plan to recommend each of the following tests?

Stool DNA periodically

* 24. I found the information in the Nevada PCP Toolkit to be helpful in increasing my understanding of colon cancer screening.

* 25. As a result of the Nevada PCP Toolkit, I will make changes in my practice regarding colon cancer screening recommendations.

* 26. I found the “Video Presentation on Increasing Colon Cancer Screening with Choice” portion of the Nevada PCP Toolkit to be useful to me.

* 27. I found the “Booklet on Essentials of Colon Cancer Screening” portion of the Nevada PCP Toolkit to be useful to me.

* 28. I found the “Patient Decision Aid on Colon Cancer Screening” portion of the Nevada PCP Toolkit to be useful to me.

* 29. I prefer watching a DVD as a way to receive continuing education about colon cancer screening.

* 30. Which other information delivery methods would you prefer? CHECK ALL THAT APPLY

* 31. What improvements to the Nevada PCP Toolkit would you recommend?

* 32. Signature and Verification of Attendance (for CME credit)

I attest that I have participated in 1.0 hours of this educational activity.

* 33. Full Name:

* 34. Degree/Credential:

* 35. Date:

* 36. Credit Type:

* 37. Please leave your address where you would like the movie tickets mailed. Thank you for participating.

Movie tickets will be mailed within 30 days of survey completion.

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