Spotting Cancer Survey Questions

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1 Q1a. Please indicate to what extent you agree or disagree with the following statement. Knowing the major signs and symptoms for cancer can help to detect the disease. 1 Disagree completely 5 Agree completely Q1b. Please indicate to what extent you agree or disagree with the following statement. Early detection of cancer improves survival rates. 1 Disagree completely 5 Agree completely Q. Please list the warning signs and symptoms of cancer you are aware of. This could be for any type of cancer. Q. Which of the following warning signs and symptoms of cancer are you aware of? Please select all that apply, including those you mentioned previously Weight loss Bowel changes Fatigue - Continuous Lumps - neck, armpit, breast, etc. White spots or patches in mouth Persistent cough Pain/ache in joints Bloating Low grade temperature for days Persistent headache - even after taking medicine Sweating at night Fingernail changes Repeat infections Falling Down Indigestion Itching in same area Bleeding - unscheduled or uncommon Skin and/or mole changes in color, shape, and size Q. If you were more aware of the most common signs and symptoms for cancer, how likely would you be to develop a plan to routinely check for them? Page 1 of 6

2 Please select one Definitely would develop a plan Probably would develop a plan Probably would not develop a plan Definitely would not develop a plan Don t know I already have an action plan Q5. Approximately how often do you do self-examination for cancer signs and symptoms? Never Less than once a year Once a year - times a year Once every months Once every months Once a month More than once a month Q6. What methods do you use to check your body for cancer signs and symptoms? Please select all that apply Routine doctor visit Self-examination Medical testing/screening Screening products bought at a store Partner helps me check Personal care assistant Other Q7. If you had a sign or symptom that you thought might be a sign of cancer, how likely would you be to contact a medical professional? Please select one Definitely would contact a medical professional Probably would contact a medical professional Might or might not contact a medical professional Probably would not contact a medical professional Definitely would not contact a medical professional Q8. How soon would you contact a medical professional after having a sign or symptom that you thought might be cancer? Please select one Within hours Within 1 week Within weeks Within 1 month Within months Within 6 months Page of 6

3 Within a year Not sure how long Q9. Which of the following are potential reasons that might prevent you from seeing a doctor or a medical professional? Please select all that apply Do not have a doctor Do not know which of my doctors to call Do not have enough money to pay for the doctor s visit Do not have insurance coverage Do not want to pay for an appointment I would be worried about the doctor thinking that I am overreacting My doctor would be difficult to talk to It is difficult to make an appointment I am too busy to make time to go the doctor I have too many other things to worry about It would be difficult to arrange transportation to the doctor I would be worried about what the doctor might find I would not feel confident talking about my symptom(s) with the doctor Other Q10. What medical testing and screening methods are available to help detect cancer (or cancer related) signs and symptoms? a. b. c. d. e. f. g. h. I do not know any Q11. Which of the following medical testing and screening methods that are available to help detect cancer (or cancer related) signs and symptoms are you aware of? Please select all that apply, including those you mentioned previously. Mammogram Colonoscopy Blood test Pap smear MRI Ultrasound Chest x-ray CAT Scan PET Scan Oral/ Mouth check by Dentist Skin scan by Dermatologist Doctor office check up Urine test Stool test Page of 6

4 Prostate Check Biopsy Genetic/Evaluation Q1. Which of the following medical testing and screening methods have been used on you? Please select all that apply. Mammogram Colonoscopy Blood test Pap smear MRI Ultrasound Chest x-ray CAT Scan PET Scan Oral/ Mouth check by Dentist Skin scan by Dermatologist Doctor office check up Urine test Stool test Prostate Check Biopsy Genetic/Evaluation Q1. What products that can be bought at a store, or online, can be used to help detect cancer (or cancer related) signs and symptoms? a. b. c. d. e. f. g. h. I do not know any Q1. Which of the following products that can be bought at a store, or online, to help detect cancer (or cancer related) signs and symptoms are you aware of? Please select all that apply, including those you mentioned previously. Accu-Cervical cancer test PSA testing by Home Health AMAS cancer test HCG cancer test kit EZ Detect EarlyCDT - Lung test MeasureBowel Health Page of 6

5 I don t know Q15. Which of the following products that can be bought at a store, or online, have you used? Please select all that apply. [PROG: PIPE IN RESPONDENT S ANSWERS FROM Q1] Q16. How interested would you be in using each of the following to find information about cancer signs and symptoms? 1 Not at all interested 5 Extremely interested A website dedicated to signs and symptoms cancer An online search engine (Google, Bing, etc.) Blogs Online videos Podcasts Social Media (Facebook, Twitter, etc.) Books Magazines or health journals Doctor or other healthcare professional Friends or family members Q16a. How interested would you be in using each of the following to find information about how to do self-examination for cancer? 1 Not at all interested 5 Extremely interested A website dedicated to how to do self-examination for cancer An online search engine (Google, Bing, etc.) Blogs Online videos Podcasts Social Media (Facebook, Twitter, etc.) Books Magazines or health journals Doctor or other healthcare professional Friends or family members Page 5 of 6

6 Q17. Which of the following describes you? Yes No Current or former student of biology or medical-related field Currently or previously worked in a healthcare-related position Q18. From the following list, please indicate who currently, or previously, had been diagnosed with cancer. Please select all that apply Yourself Your spouse/partner/significant other Grandparent Parent Child Friend Prefer not to answer [PROG: IF Q18 = PREFER NOT TO ANSWER, SKIP Q19] Q19. For the people who currently, or previously, had been diagnosed with cancer, how was the cancer first detected? [PROG: SHOW THOSE SELECTED FROM PREVIOUS QUESTION] Select one response Routine doctor visit Self-examination Medical testing/screening Screening products bought at a store Partner detected it Personal care assistant Other: Not sure Page 6 of 6

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