Review of 'Life after Cancer' Programme at FORCE

At the Force Cancer Support Centre we are constantly looking to improve the service we provide and are reviewing our programme of education and support.

It would help us if you could take a few minutes to complete the following questionnaire. You do not have to take part in this evaluation if you do not wish. Your decision will in no way affect your care or relationship with FORCE centre staff, now or in the future. Please do not add your name as all information collected is intended to be anonymous.

The survey is also available online at our website

Thankyou

Question Title

* 1. What stage are you in treatment?

Currently undergoing treatment

Surveillance/follow up

Question Title

* 2. Which of the following topics would you be interested in. Please tick 0- no interest to 5 very important

	0	1	2	3	4	5
Adjusting to side effects	Adjusting to side effects 0	Adjusting to side effects 1	Adjusting to side effects 2	Adjusting to side effects 3	Adjusting to side effects 4	Adjusting to side effects 5
Managing anxiety	Managing anxiety 0	Managing anxiety 1	Managing anxiety 2	Managing anxiety 3	Managing anxiety 4	Managing anxiety 5
Fatigue and anxiety	Fatigue and anxiety 0	Fatigue and anxiety 1	Fatigue and anxiety 2	Fatigue and anxiety 3	Fatigue and anxiety 4	Fatigue and anxiety 5
Sleep problems	Sleep problems 0	Sleep problems 1	Sleep problems 2	Sleep problems 3	Sleep problems 4	Sleep problems 5
Body image, intimacy and relationships	Body image, intimacy and relationships 0	Body image, intimacy and relationships 1	Body image, intimacy and relationships 2	Body image, intimacy and relationships 3	Body image, intimacy and relationships 4	Body image, intimacy and relationships 5
Carers	Carers 0	Carers 1	Carers 2	Carers 3	Carers 4	Carers 5
Family, children and young people	Family, children and young people 0	Family, children and young people 1	Family, children and young people 2	Family, children and young people 3	Family, children and young people 4	Family, children and young people 5
Fear of recurrence	Fear of recurrence 0	Fear of recurrence 1	Fear of recurrence 2	Fear of recurrence 3	Fear of recurrence 4	Fear of recurrence 5
Living with chronic or secondary disease	Living with chronic or secondary disease 0	Living with chronic or secondary disease 1	Living with chronic or secondary disease 2	Living with chronic or secondary disease 3	Living with chronic or secondary disease 4	Living with chronic or secondary disease 5
End of life	End of life 0	End of life 1	End of life 2	End of life 3	End of life 4	End of life 5

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* 3. Would you be happy to attend a group setting?

Yes

No, I would prefer one to one

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* 4. Would you plan to attend -

Alone

With partner

With Carer

Other (please specify)

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* 5. Would you feel strongly about a mixed gender group attending the same sessions?

No, thats not a concern to me

Yes, I would find that a concern

Comment

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* 6. Thinking about the time commitment, how many sessions would you be prepared to attend?

3-4 sessions of two hours each

4-5 sessions of two hours each

6-7 sessions of two hours each

Other (please specify)

Question Title

* 1. What stage are you in treatment?

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* 2. Which of the following topics would you be interested in. Please tick 0- no interest to 5 very important

Question Title

* 3. Would you be happy to attend a group setting?

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* 4. Would you plan to attend -

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* 5. Would you feel strongly about a mixed gender group attending the same sessions?

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* 6. Thinking about the time commitment, how many sessions would you be prepared to attend?

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* 7. Any comments?