Did You Feel Unsure About the Future After Your Initial Diagnosis?
Not at all / A little / Quite a bit / Very Much
Domain 1—information support surrounding diagnosis
- Did you feel unsure about the future after your initial diagnosis?
2. Were you afraid of your illness? / 1 / 2 / 3 / 4
- How important was it for you to be given time to ask questions about your diagnostic tests?
- How important was it for you to learn about your prognosis?
- How important was it for you to learn about the chances of your cancer spreading?
6. Did you feel that you received enough support during your diagnosis? / 1 / 2 / 3 / 4
Domain 2—impact of diagnosis on patients’ lives
7. Did the diagnosis alter your routine and lifestyle? / 1 / 2 / 3 / 4
8. Did you experience any change in financial situation? / 1 / 2 / 3 / 4
9. Did it affect your relationships with family, friends and others? / 1 / 2 / 3 / 4
Domain 3—quality of patient interactions with the healthcare team
10. How important was it for you not to be treated as just another case? / 1 / 2 / 3 / 4
11. How important was it for you to have a sense of hope conveyed to you by the hospital staff? / 1 / 2 / 3 / 4
12. How important was it for hospital staff to acknowledge your feelings? / 1 / 2 / 3 / 4
13. Were you comfortable with voicing your needs or concerns to your health care team? / 1 / 2 / 3 / 4
14. Did you feel that the members of your health care team communicated clearly with you? / 1 / 2 / 3 / 4
15. Did you feel that the members of the health care team provided enough support to assist you to make a treatment decision? / 1 / 2 / 3 / 4
16. Were you prepared to ask your health care team questions about your treatment? / 1 / 2 / 3 / 4
Domain 4—decision support from the healthcare team
17. Were you given written information about your treatment options? / 1 / 2 / 3 / 4
18. Was information about treatment options given verbally by your health care team? / 1 / 2 / 3 / 4
19. Were you informed about treatment options using visual aids such as diagrams? / 1 / 2 / 3 / 4
20. Were you informed of the risks, benefits and side-effects of each treatment option? / 1 / 2 / 3 / 4
21. Did you feel your knowledge about your illness improved after the consultation? / 1 / 2 / 3 / 4
22. Were you given an opportunity to discuss any questions with your health care team? / 1 / 2 / 3 / 4
23. Did you feel you wanted to ask more questions after leaving the consultation? / 1 / 2 / 3 / 4
24. Were you informed how each treatment option reduces your chance of recurrence? / 1 / 2 / 3 / 4
25. Did you actively participate in making your final treatment decision? / 1 / 2 / 3 / 4
26. Were you given choices for different treatment options? / 1 / 2 / 3 / 4
27. Were you able to make the final treatment decision yourself? / 1 / 2 / 3 / 4
28. Did you consider family members or others close to you when making your treatment decision? / 1 / 2 / 3 / 4
29. How important were personal financial issues to you when making your treatment decision? / 1 / 2 / 3 / 4
30. How important were side effects of treatment to you when making your treatment decision? / 1 / 2 / 3 / 4
Domain 5—additional information needs surrounding treatment decision: please indicate how valuable each of these areas were or would have been while making a decision to start treatment?
31. To be accompanied by family members or friends to appointments? / 1 / 2 / 3 / 4
32. To be given printed educational materials such as information sheets, pamphlets, booklets? / 1 / 2 / 3 / 4
33. To be given a chance to ask questions or be given explanations? / 1 / 2 / 3 / 4
34. To be given a worksheet to make a list of questions to ask the health care team to answer during the meeting? / 1 / 2 / 3 / 4
35. To be given a written summary of the points discussed with your physicians (surgeon, medical oncologist, radiation oncologist) after the consultation? / 1 / 2 / 3 / 4
36. To be given a list of useful internet websites? / 1 / 2 / 3 / 4
37. To be offered a workbook that included treatment information, benefits, and side-effects tailored to help guide you towards a treatment decision? / 1 / 2 / 3 / 4
38. Were you informed of support groups in your area? / 1 / 2 / 3 / 4
39. Were you prepared to discuss treatment options? / 1 / 2 / 3 / 4
40. Were you given access to professional counseling (social worker, nurse specialist, psychologist) if you or your family members needed it? / 1 / 2 / 3 / 4
Domain 6—information support during radiation treatment: please indicate how important each of these items was during your treatment experience?
41. To be told beforehand what to expect during radiation? / 1 / 2 / 3 / 4
42. To be told beforehand what to expect after radiation? / 1 / 2 / 3 / 4
43. Travel distance to Odette Cancer Center? / 1 / 2 / 3 / 4
44. To be provided with information about volunteer drivers? / 1 / 2 / 3 / 4
45. To be given material for family members about family support resources? / 1 / 2 / 3 / 4
46. To be supported by family members or friends during treatment? / 1 / 2 / 3 / 4
Overall Support
47. Overall, I would grade my decisional support during my treatment:
1 - Inadequate2 - Unsatisfactory 3 - Neutral4 - Satisfactory5 - Excellent
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