Cancer Survival Toolbox Survey

NCCS hopes that the Cancer Survival Toolbox was useful and we would appreciate your feedback. Please take the time to fill out this very short survey. Your responses will provide NCCS with valuable information about the program. You can also provide feedback on the multiple myeloma module.

If you have any questions about NCCS or the Cancer Survival Toolbox, please call our toll-free number, 877-TOOLS-4-U for more information.

1. How would you describe yourself? Please check all that apply:
Survivor


2. When did you receive the Cancer Survival Toolbox (month, date, year)? 
  


3. What is today's date? 
 


4. Was the Cancer Survival Toolbox useful? 
Very Useful      Somewhat Useful      Neutral      Somewhat Not Useful      Not at All Useful
                                                                                                              


5. Which parts of the Cancer Survival Toolbox did you find most useful? Please check all that apply: 
 Communicating                       Topics for Older Persons
Finding Information                  Finding Ways to Pay for Care
Making Decisions                      Caring for the Caregiver
 Solving Problems                    Living Beyond Cancer
 Negotiating                               Dying Well - The Final Stage of Survivorship
Standing Up for Your Rights   Resource Guide (booklet that is including in the package)
 First Steps for the
       Newly Diagnosed                       


6. Have you talked about the materials with anyone?
Yes No

           If yes, please check all that apply:
               Family Member/Caregiver 
               Friend
               Health Professional
               Clergy Member
               Other:   


7. After listening to the Cancer Survival Toolbox, to what extent are you able to:

                                                                                   A great deal........................................Not at all

Communicate with doctors, nurses,
family members, and others?                                                               
Find information about cancer treatments?                                        
Make informed choices about cancer care?                                       
Form a plan to solve a problem of special
concern to you?                                                                                   
Negotiate with your family and
healthcare team to get your needs met?                                              
Stand up for your rights?                                                                       


8. How likely are you to recommend the Cancer Survival Toolbox to others in your situation? 
Very Likely      Somewhat Likely      Neutral      Somewhat Unlikely      Not at All Likely
                                                                                                      


9. How did you learn about the Cancer Survival Toolbox?


10. Please share how the Cancer Survival Toolbox has helped you:


   
 

SURVIVOR PROFILES

Merv Williams, three-year prostate cancer survivor

Life has many challenges, but it’s our response to the toughest tests that proves our mettle. When I was diagnosed with prostate cancer in 2007, I knew I had no other choice but to survive first and then make the most of my experience.
Read More | Leave a Comment | Submit Your Story