30-DAY FOLLOW-UP SURVEY (TELEPHONE TRANSCRIPT)

Transcription

1 30-DAY FOLLOW-UP SURVEY (TELEPHONE TRANSCRIPT) Hello, my name is <Name>. I m working with the doctors at the Jefferson Multidisciplinary Clinic. May I please speak to <Patient Name>? IF NOT THERE: Do you know of a better time when I can reach him/her? (NOTE TIME TO CALL BACK) IF THERE: Continue on You may recall meeting with a member of our study team at the Jefferson Multidisciplinary Clinic about a month ago. I m calling to complete the final follow up survey to that visit. Do you have about 20 minutes to go through the survey? IF YES: Great, thank you! (CONTINUE TO SURVEY) IF NO: Is there a better time when I can contact you? (NOTE DAY/TIME TO CALL BACK):

2 A. Knowledge Please answer the following questions, to the best of your knowledge, about prostate cancer and the options available for treatment. True False Don t Know A1 A2 A3 A4 A5 A6 A7 A8 A9 A10 The prostate is a gland that is part of a man s reproductive system. Low-risk prostate cancer is localized to the prostate and is slow-growing. Active surveillance is when your doctor closely watches for any sign that your prostate cancer is changing or growing. Active surveillance is an option for men with high risk prostate cancer. Brachytherapy is a type of internal radiation therapy in which a doctor places radioactive material inside the prostate. Active treatment options for low-risk prostate cancer include surgery and radiation therapy. The side effects of active treatment are avoided during active surveillance. The side effects for active treatment may last for a year or more. Men who initiate active surveillance can still be candidates for active treatment in the future. Long-term survival is higher for men who initiate active treatment than for those who initiate active surveillance.

3 B. Perceptions The following questions pertain to your thoughts about your prostate cancer, including the chance of developing aggressive, or late-stage, disease and initiating active surveillance for treatment. Please tell us how much you agree or disagree with the following statements. B1 B2 B3 B4 B5 B6 I believe I am at low risk of developing aggressive disease. Starting active surveillance is an important thing to do. Starting active surveillance can protect my health. Starting active surveillance makes sense to me. I am afraid that Starting active surveillance would reduce my chance of being cured. I am concerned that I might develop aggressive prostate cancer. Neither or B7 B8 B9 B10 B11 I think it is likely that I will develop aggressive prostate cancer in the future. I think that the chance that I will develop aggressive prostate cancer is high. I believe that starting active surveillance would allow me to live a long, healthy life. I want to do what members of my family think I should do about starting active surveillance. Members of my family think I should start active surveillance.

4 B12 B13 B14 B15 I want to do what my doctor thinks I should do about starting active surveillance. My doctor thinks I should start active surveillance. Starting active surveillance would be an easy thing to do. Arranging my schedule to start active surveillance is an easy thing to do. C. Decisional Conflict The next set of statements are about your thoughts on making a decision about treatment. Please circle the number that indicates how much you agree or disagree with each of the following statements. C1 C2 C3 C4 C5 C6 C7 C8 C9 I know which options are available to me. I know the benefits of each option. I know the risks and side effects of each option. I am clear about which benefits matter most to me. I am clear about which risks and side effects matter most. I am clear about which is more important to me (the benefits or the risks and side effects). I have enough support from others to make a choice. I am choosing without pressure from others. I have enough advice to make a choice. Neither or

5 C10 I am clear about the best choice for me. C11 I feel sure about what to choose. C12 The decision is easy for me to make D. Understanding of Treatment Information The next set of questions are about your understanding of the treatment options available to you. Please respond about how you feel to each of the following statements. D1 D2 D3 How well do you understand the information you have received about prostate cancer treatment? How well do you understand the possible advantages and disadvantages that prostate cancer treatments may cause? Overall, how prepared do you feel about what to expect with regard to possible changes to your health and lifestyle after treatment? Not at All A Little Bit Somewhat Quite a Bit Extremely Well E. Current Decision Status E1. Have you made a decision about treatment? Yes No E2. If yes, what steps have you taken toward initiating your treatment plan?