MAKING YOUR TREATMENT DECISION
My difficulty in making this choice
Which treatment option do you prefer? Please checkone box.
Radical Prostatectomy (Surgery)
External beam Radiation or other radiation
Active Surveillance
Other
Unsure
Considering the option you prefer, please answer the following questions:
Yes / Probably yes / Unsure / Probably no / No1.Do you know which options are available to you? / / / / /
2.Do you know the benefits of each option? / / / / /
3.Do you know the risks and side effects of each option? / / / / /
4.Are you clear about which benefits matter most to you? / / / / /
5.Are you clear about which risks and side effects matter most to you? / / / / /
6.Are you clear about which is more important to you (the benefits or the risks and side effects)? / / / / /
7.Do you have enough support from others to make a choice? / / / / /
8.Are you choosing without pressure from others? / / / / /
Yes / Probably yes / Unsure / Probably no / No
9. Do you have enough advice to make a choice? / / / / /
10. Are you clear about the best choice for you? / / / / /
11. Do you feel sure about what to choose? / / / / /
12. Is this decision easy for you to make? / / / / /
13. Do you feel you have made an informed choice? / / / / /
14. Does your decision show what is important to you? / / / / /
15. Do you expect to stick with your decision? / / / / /
16. Are you satisfied with your decision? / / / / /
PROSTATE CANCER KNOWLEDGE
The prostate is located between the bladder and penis, in front of the rectum.
True
Not Sure
False
If you have brothers or sons they are at higher risk for prostate cancer.
True
Not Sure
False
A man can have prostate cancer without having any pain or symptoms.
True
Not Sure
False
Antibiotics can be used to cure prostate cancer.
True
Not Sure
False
The goal of hormone therapy is to lower the levels of the male hormone, testosterone.
True
Not Sure
False
Surgery or radiation can cure prostate cancer in its early stage.
True
Not Sure
False
Chemotherapy is given to men with early prostate cancer.
True
Not Sure
False
Hormone treatment for prostate cancer can cause hot flashes.
True
Not Sure
False
Prostate cancer treatment can increase your sex drive.
True
Not Sure
False
Radiation treatment of prostate cancer can cause urinary or sexual problems.
True
Not Sure
False
Surgery of prostate cancer can cause urinary or sexual problems.
True
Not Sure
False
For some prostate cancers, just using a “watchful waiting” approach works as well as surgery or radiation to let a man live out his normal lifespan.
True
Not Sure
False
SATISFACTION WITH PROSTATE CANCER CARE
Please indicate the answer that best describes your feeling about each aspect of the prostate cancer services you have received. We are interested in your overall experience during the last yearwith prostate cancer care or treatment that you have received related to your prostate cancer treatment or its side effects. By "practitioner" we mean the one or more doctors, clinicians, etc., who have worked with you in your prostate cancer-related care.
What is your overall feeling about the… / Delighted / Mostly Satisfied / Mixed / Mostly dissatisfied / Terrible1.Effect of health care services in helping you deal with your cancer and maintain your well-being? / / / / /
2.Professional knowledge and competence of your main cancer practitioner(s)? / / / / /
3.Ability of your main cancer practitioner(s) to listen and respond to your concerns or problems? / / / / /
4.Personal manner of the main cancer practitioner(s) seen? / / / / /
5.Waiting time between asking to be seen or treated and the appointment given? / / / / /
6.Waiting time when you come for an appointment? / / / / /
7.Availability of appointment times that fit your schedule? / / / / /
8.Effect of cancer treatment in preventing cancer progression or recurrence? / / / / /
What is your overall feeling about the… / Delighted / Mostly Satisfied / Mixed / Mostly dissatisfied / Terrible
9. How well your confidentiality and rights as an individual have been protected? / / / / /
10. Quality of cancer care you have received? / / / / /
11. Availability of information on how to get the most out of the cancer care and related services? / / / / /
12. Explanations of specific procedures and treatment approaches used? / / / / /
13. Effect of services in helping relieve symptoms or reduce problems? / / / / /
14. Thoroughness of the main cancer practitioner(s) you have seen? / / / / /
15. Helpfulness of the information provided about your cancer and its treatment? / / / / /
16. In an overall general sense, how satisfied are you with the cancer treatment you have received? / / / / /
SHARED DECISION MAKING
In the selection of the treatment method, my thoughts were taken into account just as much as the consideration of my doctor.
Strongly Agree
Agree
Disagree
Strongly Disagree
There was enough time for questions.
Strongly Agree
Agree
Disagree
Strongly Disagree
My doctor and I weighed up the different treatment options thoroughly.
Strongly Agree
Agree
Disagree
Strongly Disagree
I was able to discuss the different treatment options with my doctor in detail.
Strongly Agree
Agree
Disagree
Strongly Disagree
My doctor and I selected a treatment option together.
Strongly Agree
Agree
Disagree
Strongly Disagree
I now know the advantages of the individual treatment options.
Strongly Agree
Agree
Disagree
Strongly Disagree
I now know which treatment option is the best one for me.
Strongly Agree
Agree
Disagree
Strongly Disagree
During the consultation, I felt included in the treatment decision.
Strongly Agree
Agree
Disagree
Strongly Disagree
Through the consultation with the doctor, I felt jointly responsible for my further treatment.
Strongly Agree
Agree
Disagree
Strongly Disagree
My doctor and I discussed the next steps of the treatment plan in detail.
Strongly Agree
Agree
Disagree
Strongly Disagree
My doctor and I reached an agreement as to how we will proceed.
Strongly Agree
Agree
Disagree
Strongly Disagree
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