Protocol - Patient Experience with Cancer Care - Cancer Surgery

Answer each question by marking the box to the left of your answer.

You are sometimes told to skip over some questions in this survey. When this happens, you will see an arrow with a note that tells you what questions to answer next, like this:

[ ] Yes

[x] No - If No, go to #1 on page 3

Contacting Your Cancer surgery Team

1. Cancer surgery team refers to the doctors, nurses, therapists, technicians, and their support staff involved with your cancer surgery through this cancer center. Since it was decided that you would have cancer surgery, did your cancer surgery team encourage you to contact them with questions between visits?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

2. Since it was decided that you would have cancer surgery, did your cancer surgery team tell you to call them immediately if you have certain symptoms or side effects?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

3. Since it was decided that you would have cancer surgery, did your cancer surgery team give you clear instructions about how to contact them after regular office hours?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

4. Since it was decided that you would have cancer surgery, did your cancer surgery team involve your family members or close friends in discussions about your cancer or cancer care as much as you wanted?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

5. When was the last time you received cancer surgery for cancer from this cancer center?

[ ] In the last 6 months

[ ] More than 6 months ago - If more than 6 months ago, end survey

Your Care Team from This Cancer Center

6. In the last 6 months, how many times did you visit this cancer center to get care from your cancer surgery team? Do not include telephone calls or emails.

[ ] None - If None, end survey

[ ] 1 to 5 times

[ ] 6 to 10 times

[ ] 11 or more times

7. In the last 6 months, did you contact this cancer center to get an appointment for an illness, injury, or condition that needed care right away?

[ ] Yes

[ ] No - If No, go to #9

8. In the last 6 months, when you contacted this cancer center to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

9. In the last 6 months, did you make any appointments for a check - up or routine care at this cancer center?

[ ] Yes

[ ] No - If No, go to #11

10. In the last 6 months, when you made an appointment for a check - up or routine care at this cancer center, how often did you get an appointment as soon as you needed?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

11. In the last 6 months, did you contact this cancer center with a medical question during regular office hours?

[ ] Yes

[ ] No - If No, go to #13

12. In the last 6 months, when you contacted this cancer center during regular office hours, how often did you get an answer to your medical question that same day?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

Your Cancer Surgery Team

13. Cancer surgery team refers to the doctors, nurses, therapists, technicians, and their support staff involved with your cancer surgery through this cancer center. In the last 6 months, how often did your cancer surgery team explain things in a way that was easy to understand?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

14. In the last 6 months, how often did your cancer surgery team listen carefully to you?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

15. In the last 6 months, how often did your cancer surgery team seem to know the important information about your medical history?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

16. In the last 6 months, how often did your cancer surgery team show respect for what you had to say?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

17. In the last 6 months, how often did your cancer surgery team spend enough time with you?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

18. In the last 6 months, did your cancer surgery team order a blood test, x - ray, or other test for you? Do not include cancer surgery.

[ ] Yes

[ ] No - If No, go to #20

19. In the last 6 months, when you had blood tests, x - rays, or other tests as part of your cancer treatment, how often did someone from this cancer center follow up to give you those results?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

20. In the last 6 months, did you take any prescription medicine?

[ ] No - If No, go to #22

[ ] Yes

21. In the last 6 months, how often did you and your cancer surgery team talk about all the prescription medicines you were taking?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

22. In the last 6 months, did you and your cancer surgery team talk about pain related to your cancer or cancer surgery?

[ ] Yes

[ ] No

23. In the last 6 months, were you bothered by pain from your cancer or cancer surgery?

[ ] Yes

[ ] No - If No, go to #25

24. In the last 6 months, did your cancer surgery team advise you about or help you deal with this pain?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

25. In the last 6 months, did you and your cancer surgery team talk about any changes in your energy levels related to your cancer or cancer surgery?

[ ] Yes

[ ] No

26. In the last 6 months, were you bothered by changes in your energy levels related to your cancer or cancer surgery?

[ ] Yes

[ ] No - If No, go to #28

27. In the last 6 months, did your cancer surgery team advise you about or help you deal with these changes in your energy levels?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

28. In the last 6 months, did you and your cancer surgery team talk about any emotional problems, such as anxiety or depression, related to your cancer or cancer surgery?

[ ] Yes

[ ] No

29. In the last 6 months, were you bothered by any emotional problems, such as anxiety or depression, related to your cancer or cancer surgery?

[ ] Yes

[ ] No - If No, go to #31

30. In the last 6 months, did your cancer surgery team advise you about or help you deal with these emotional problems?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

31. Additional services to manage your cancer care at home include home health care, special medical equipment, or special supplies. In the last 6 months, did you and your cancer surgery team talk about these additional services?

[ ] Yes

[ ] No

32. In the last 6 months, did you and your cancer surgery team talk about things you can do to maintain your health during cancer treatment such as what to eat and what exercises to do?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

33. Using any number from 0 to 10, where 0 is the worst cancer surgery team possible and 10 is the best cancer surgery team possible, what number would you use to rate your cancer surgery team?

0[ ]Worst cancer surgery team possible

1[ ] 

2[ ] 

3[ ] 

4[ ] 

5[ ] 

6[ ] 

7[ ] 

8[ ] 

9[ ] 

10[ ]Best cancer surgery team possible

34. An interpreter is someone who helps you talk with others who do not speak your language. Interpreters can include staff from this cancer center, telephone interpreters, friends, or family members. In the last 6 months, was there any time when you needed an interpreter at this cancer center?

[ ] Yes

[ ] No - If No, go to #36

35. In the last 6 months, when you needed an interpreter to speak with your cancer surgery team, how often did you get one?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

36. Considering all your cancer care at this cancer center, using any number from 0 to 10, where 0 is the worst overall cancer care experience possible and 10 is the best overall cancer care experience possible, what number would you use to rate your overall cancer care experience?

0[ ]Worst overall cancer care experience possible

1[ ] 

2[ ] 

3[ ] 

4[ ] 

5[ ] 

6[ ] 

7[ ] 

8[ ] 

9[ ] 

10[ ]Best overall cancer care experience possible

Access

37. In the last 6 months, did you contact this cancer center with a medical question after regular office hours?

[ ] Yes

[ ] No - If No, go to #39

38. In the last 6 months, when you contacted this cancer center after regular office hours, how often did you get an answer to your medical questions as soon as you needed?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

39. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

Information from Providers

40. Since it was decided that you would have cancer surgery, did your cancer surgery team clearly explain how your cancer and cancer surgery] could affect your normal daily activities?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

41. In the last 6 months, did your cancer surgery team tell you what the next steps in your cancer surgery would be?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

42. In the last 6 months, how often did your cancer surgery team explain those results in a way that was easy to understand?

[ ] Never

[ ] Sometimes

[ ] Usually

[ ] Always

43. In the last 6 months, did your cancer surgery team prescribe medicine that you had not taken before?

[ ] Yes

[ ] No

44. In the last 6 months, did your cancer surgery team explain what that medicine was for in a way that was easy to understand?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

Shared Decision Making

45. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about more than one way to treat your cancer?

[ ] Yes

[ ] No - If No, go to #49

46. Since your career was diagnosed, did a doctor or other health care professional at this cancer center clearly explain the advantages of each choice for cancer treatment, including the treatments you did not get?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

47. Since your cancer was diagnosed did a doctor or health care professional at this cancer center clearly explain the disadvantages of each choice for cancer treatment, including the treatments you did not get?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

48. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center ask for your opinion about each choice of cancer treatment, including the treatments you did not get?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

49. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about the reason you might want to have cancer surgery?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

50. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about the reasons you might not want to have cancer surgery?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

51. Since your cancer was diagnosed, when you talked about having cancer surgery, did a doctor or other health care professional at this cancer center ask you what you thought was best for you?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No

52. Since your cancer was diagnosed, did a doctor or health professional at this cancer center involve you in decisions about your cancer treatment as much as you wanted?

[ ] Yes, definitely

[ ] Yes, somewhat

[ ] No