Typical American Cancer Society Questionnaire

While reviewing the following ACS questionnaire, 
please keep it in your mind that there is no mention of prevention anywhere in the questionnaire.

Treatment is the main thrust of this organization, with little but lip service paid to prevention.

---

Thank you for participating in our survey. The information you provide will be kept confidential by ACS and will not be distributed. Please answer the following questions:

1)      Which best describes your relationship to cancer?

• Newly diagnosed patient (not yet in treatment)

• Patient undergoing treatment

• Survivor (completed treatment/in remission)

• Supporter (family)

• Supporter (friend)

2)      What type of cancer does/did you or your loved one have?

• Breast

• Colon/rectal

• Leukemia

• Lung

• Melanoma

• Non-Hodgkin’s lymphoma

• Gynecological

• Pancreas

• Prostate

• Other

3)      What type of treatment does/did you or your loved one receive?

• Newly diagnosed patient (not yet in treatment)

• Patient undergoing treatment

• Survivor (completed treatment/in remission)

• Supporter (family)

• Supporter (friend)

4)      Which role(s) has been your primary focus during your involvement with cancer?

• Patient - receive treatment/therapy and focus on healing
• Advocate - ensure treatment decisions are appropriate
• Researcher - interpret information for diagnosis/treatment
• Liaison - primary link w/ medical team and insurance companies
• Mentor - share experience w/ others to make decisions
• Educator - raise awareness of cancer w/ wider public
• Activist - participate in volunteer activities
• Intimate supporter - provide comfort and assist w/ care
• Empathetic supporter - provide support based on experience

5)      What are your most important goals?

For questions 6 & 7, please rank the goals for each question in order of priority. For example, if "Evaluate treatment options" was your top goal, please rank it "First priority". If a goal did not apply to your situation, select N/A.

6)      Deciding Goals - Prioritize goals you had when deciding on a treatment.

1 First priority 2 Second priority 3 Third priority 4 Fourth priority 5 Fifth priority

• Evaluate treatment options - research treatment issues, decide on a doctor and treatment.
• Manage impacts of treatment - address logistics of scheduling/record-keeping/transportation, consider how affects on family and employment.
• Enlist a support network - ask others for help, gather emotional/practical support from family and friends.
• Begin to seek a peer group - find and make contact with other patients or supporters
• Acknowledge beginning of treatment - express reactions and process the experience, both individually and collectively.

7)      Coping Goals - Prioritize goals you had while receiving treatment

1 First priority 2 Second priority 3 Third priority 4 Fourth priority 5 Fifth priority

• Monitor treatment process - coordinate communication between physician/patient/supporters, learn what to expect physically and emotionally.
• Manage logistics of treatment - coordinate schedule, arrange transportation, keep records, negotiate w/ insurance.
• Manage bodily changes - understand how treatment affects body, address side effects, learn coping tips/tricks.
• Process the psychological impacts - reconcile changes in body with self esteem and relationship w/ others.

What are your most important needs?
For questions 8 - 15, please rank the following needs in order of priority. The needs are for the goals ranked previously in questions 6 & 7

8)      Needs for "Evaluate treatment options" goal -

1 First priority 2 Second priority 3 Third priority

• Find info about the reputability of doctors and facilities
• Research concerning issues related to treatment
• Learn how to read and interpret medical info

9)      Needs for "Manage impacts of treatment" goal -

1 First priority 2 Second priority

• Consider how treatment will affect employment & family status
• Adress logistics of scheduling, record-keeping, and transportation for treatment

10)      Needs for "Enlist a support network" goal

1 First priority 2 Second priority 3 Third priority

• Ask others for help with treatment
• Gather emotional and practical support from family/friends
• Help members of support network allocate responsibilities to themselves

11)      Needs for "Monitor treatment process" goal

1 First priority 2 Second priority 3 Third priority

• Coordinate effective communication between medical team, patient, and family
• Learn how to read and understand medical results (possible treatment outcomes expressed as percentages, ranges and thresholds, statistics)
• Conduct conversations with medical team about what to expect physically and emotionally during treatment

12)      Needs for "Manage logistics of treatment" goal -

1 First priority 2 Second priority 3 Third priority 4 Fourth priority

• Coordinate treatment schedule
• Negotiate with insurance providers and managed finances
• Arrange transportation to and from treatment
• Establish record keeping routines for treatment

13)      Needs for "Manage bodily changes" goal

1 First priority 2 Second priority 3 Third priority

• Evaluate how treatment process affected bodily changes
• Learn about coping tips and tricks from other cancer sufferers
• Address issues concerning side effects

14)      Needs for "Process the psychological impacts of treatment" goal

1 First priority 2 Second priority

• Reconcile experiences of feeling sick with medical evaluations of treatment process
• Address impact of major bodily changes in regards to self esteem, gender and sexuality, and relationships with others

15)      Needs for "Build effective relationships" goal

1 First priority 2 Second priority 3 Third priority

• Communicate fears and concerns with medical team, family, and friends
• Help family and friends to accept changes in patient's body
• Seek other cancer patients who experienced similar bodily side effects

16)      How useful is cancer.org in supporting your goals and needs?

• Very useful
• Somewhat useful
• Neither useful nor unuseful
• Somewhat unuseful
• Very unuseful

17)      How easy to use is cancer.org?

• Very usable
• Somewhat usable
• Neither usable nor unusable
• Somewhat unusable
• Very unusable

18)      What is your level of computer experience?

• Non-user (can't use without help)
• Novice (can use with some help)
• Experienced (can use with little or no help)
• Expert (help others to use)

Thank you for your feedback. Your input will help cancer.org make an impact in the fight against cancer

If you have come to this page from an outside location click here to get back to mindfully.org