!Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine
Session 8: Fear of Recurrence - How to Conquer It
Date: ______Location: ______
General Information Survey
BEFORE VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY
Instructions: Please circle the correct answer/s:
1- I attended this session:
In-person Via Videoconference Via internet DVD/ VHS
2- I am a (please circle all that apply):
Breast cancer survivor (anyone with a diagnosis of breast cancer)
Relative of a breast cancer survivor
Lay health worker/ promoter
Caregiver of a breast cancer survivor
CPG (Community Partner Group member –assisted in project development)
Health care provider (please specify) ______
Other ______
3- My place of residence is in the following city/town/ rural area______
4- My health insurance is:
Private (please specify) (HMO/ PPO) ______
AHCCCS
Other______
No health insurance
5- The following describe me: Age ______Gender ______
6- I describe my ethnicity as: Hispanic Non-Hispanic
7- I describe my race as:
American Indian Pacific Islander White
Asian African American Other (please specify) ______
8- The highest grade of school that I completed is ______
9- At home, I speak:
English only Spanish only
English and Spanish Other (please specify) ______
10- I needed this presentation translated into Spanish. Yes No
11- I prefer the English to Spanish translation to be:
Written Spoken I have no preference Not applicable to me
12- How did you hear about this session? ______
13- Did you attend a session before? No Yes
If yes, this is my #1, #2, #3, #4, #5,#6,#7, #8 session attended
¡Vida! Pre-Assessment Survey
BEFORE VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY
Session 8: Fear of Recurrence - How to Conquer It
Please read the following questions and provide the best answer:
1. My knowledge about this topic is: (circle only one answer)
none at all very little somewhat a lot
2. What does not influence the fear of recurrence?
a. prognosis
b. personality
c. worries about family, finances, job, etc.
d. astrological sign
e. confidence in my medical team
3. What is most helpful in coping with fear of recurrence?
a. ignoring it
b. a cocktail
c. facing it
d. calling your doctor every day
4. What impact can the fear of recurrence have on your life?
a. leads to multiple losses (health, job, relationships, etc.)
b. improves sleep
c. increases confidence
d. prevents depression or anxiety
e. allows for more hopefulness
5. What can family and friends do to be helpful?
a. give advice
b. continually saying “you’ll be fine”
c. telling stories about everyone else they know who had cancer
d. ask you what you need and listen for the answer
e. make assumptions about what you need
6. What is not a common trigger for fear of recurrence?
a. some new ache or pain
b. a random act of kindness
c. doctor appointments
d. anniversary dates for diagnosis, cancer testing, etc.
e. awaiting test results
7. What are some ways to obtain information regarding resources available?
a. By my astrological sign
b. I do not know
c. There are no resources available
d. On the internet, attending conferences or seminars
PLEASE DO NOT COMPLETE ANY ADDITIONAL FORMS
UNTIL AFTER YOU HAVE VIEWED THE ENTIRE PRESENTATION
PLEASE PROCEED AND VIEW
THE VIDA! PRESENTATION
Educational Objectives for this Session
1- Identify critical time points that may trigger fear of cancer
recurrence
2- Outline specific coping strategies to deal with the fear of cancer
recurrence
3- Identify community resources
Session Satisfaction Survey
AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY
STRONGLY DISAGREE / DISAGREE / NO OPINION / AGREE / STRONGLY AGREE1- Videoconferencing, DVD/ VHS, attending via internet made my attendance possible / 1 / 2 / 3 / 4 / 5
2 -I was able to speak freely and ask questions. / 1 / 2 / 3 / 4 / 5
3- I learned new information. / 1 / 2 / 3 / 4 / 5
4- The teaching techniques were conducive to learning. / 1 / 2 / 3 / 4 / 5
5- The information presented was appropriate for my needs. / 1 / 2 / 3 / 4 / 5
6- The handouts were useful for the session. / 1 / 2 / 3 / 4 / 5
7- The educational objectives were met. / 1 / 2 / 3 / 4 / 5
8- The speaker was prepared and informative. / 1 / 2 / 3 / 4 / 5
9- I was comfortable with the camera and other equipment. / 1 / 2 / 3 / 4 / 5
10- I was able to hear questions from the other locations. / 1 / 2 / 3 / 4 / 5
11- I had no trouble hearing the presenter. / 1 / 2 / 3 / 4 / 5
12- I could see the presenter clearly during the session. / 1 / 2 / 3 / 4 / 5
13- My experience was as good as seeing the speaker face to face. / 1 / 2 / 3 / 4 / 5
14- The English-Spanish translation did not distract me from the content of the presentation. / 1 / 2 / 3 / 4 / 5
15- The English to Spanish translation did not make the session too long. / 1 / 2 / 3 / 4 / 5
16- Overall, I am satisfied with this training. / 1 / 2 / 3 / 4 / 5
The information you have provided will help to increase our body of knowledge
about how well this educational session has met your needs and expectations
¡Vida! Post-Assessment Survey
AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY
Session 8: Fear of Recurrence - How to Conquer It
Please read the following questions and provide the best answer:
1. After viewing this presentation, my knowledge about this topic is: (circle the best answer)
none at all very little somewhat a lot
2. What does not influence the fear of recurrence?
f. prognosis
g. personality
h. worries about family, finances, job, etc.
i. astrological sign
j. confidence in my medical team
3. What is most helpful in coping with fear of recurrence?
e. ignoring it
f. a cocktail
g. facing it
h. calling your doctor every day
4. What impact can the fear of recurrence have on your life?
f. leads to multiple losses (health, job, relationships, etc.)
g. improves sleep
h. increases confidence
i. prevents depression or anxiety
j. allows for more hopefulness
5. What can family and friends do to be helpful?
f. give advice
g. continually saying “you’ll be fine”
h. telling stories about everyone else they know who had cancer
i. ask you what you need and listen for the answer
j. make assumptions about what you need
6. What is not a common trigger for fear of recurrence?
f. some new ache or pain
g. a random act of kindness
h. doctor appointments
i. anniversary dates for diagnosis, cancer testing, etc.
j. awaiting test results
7. What are some ways to obtain information regarding resources available?
a. By my astrological sign
b. I do not know
c. There are no resources available
d. On the internet, attending conferences or seminars
Thank you very much for taking the time to complete all study forms
You may submit the completed forms in any of the following ways:
Via fax: (520) 626-2225 ATTN: Angela Valencia
Via mail: Arizona Cancer Center
ATTN: Angela Valencia
1515 N. Campbell Ave
Tucson, AZ 85724
or
Via e-mail to:
If you have any questions please call:
Bettina Hofacre at (520) 626-3265
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Vida! Session Packet for all Participants PLEASE KEEP ALL FORMS TOGETHER