Survey of Experiences with Paxlovid(R) as a Treatment for COVID-19

Survey Demographics

Patient survey on Paxlovid(R) COVID-19 treatment. We invite all who have received Paxlovid(R) as a treatment for one or more COVID-19 infections, or those who have not received Paxlovid(R) but might receive it for a future COVID-19 infection, to complete this survey.

This survey is intended to gather patient/caregiver perspectives to inform the Save Your Skin Foundation treatment recommendations to the CADTH Common Drug Review (CDR). By providing direct patient feedback we can help inform decision-makers as to the patient need, and potentially increase treatment options and access, therefore improving treatment outcomes.

This survey should take approximately 15 minutes to complete in full. Please contact us at info@saveyourskin.ca with any questions or additional feedback. Thank you.

Paxlovid(R) is for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults with positive results of direct sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid (R) consists of 2 medicines: nirmatrelvir tablets and ritonavir tablets. The 2 medicines are taken together 2 times each day for 5 days.

Please note that while Save Your Skin Foundation is a non-profit dedicated to melanoma, non-melanoma skin cancers, and ocular melanoma, this survey is open to everyone who has received Paxlovid(R) or might benefit from it in the future; you do not need to have experienced one of the diseases related to Save Your Skin Foundation’s mandate to take this survey. While this survey was developed by Save Your Skin Foundation, we acknowledge and appreciate the efforts of all of those who offered feedback on this survey and are sharing it to their networks.

Section 1: Survey Demographics

Question Title

* 1. What is your gender?

Female

Male

Non-binary

Prefer not to say

Prefer to self-describe

Question Title

* 2. What is your age?

18-29

30-49

50-59

60-69

70-79

80-89

90 or older

Prefer not to say

Question Title

* 3. If you live in Canada, in what province/territory do you reside?

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Newfoundland & Labrador

Prince Edward Island

Yukon, Northwest Territory, or Nunavut

I do not live in Canada

Question Title

* 4. If you do not live in Canada, in what country do you reside?

Question Title

* 5. Please indicate what you consider your “primary” health concern. You will have the opportunity to list other health concerns in the next question.

Question Title

* 6. Please list any other major health concerns you are currently facing, other than what you previously listed as your primary health concern.

Question Title

* 7. Below are listed the factors (according to Health Canada) that place patients at high risk of progression to severe COVID-19. Please select every factor that applies to you. Please feel free to list anything else you feel might be relevant under “other.”
Please note that other medical conditions or factors (i.e., race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and is not limited to the medical conditions or factors listed.

60 years of age or older

Currently pregnant

Have Down syndrome

Have not received all of your recommended COVID-19 vaccine doses

Have a chronic medical condition, such as: asthma (moderate to severe), dementia, diabetes, heart disease, high blood pressure, kidney disease, liver disease, lung disease, stroke

Are immunocompromised, including if you: have an underlying medical condition, such as cancer; take medications that reduce the immune response, such as chemotherapy; have had a solid organ or blood stem cell transplant

If you live with obesity (if you have a body mass index (BMI) of 40 or more)

Other (please specify)

Section 2: COVID-19 Related Questions

Question Title

* 8. Have you been vaccinated against COVID-19? If possible, please indicate which brand of vaccine(s) you have received in the comment box.

I have received the first two COVID-19 vaccinations

I have received the first two COVID-19 vaccinations plus one booster

I have received the first two COVID-19 vaccinations plus two boosters

I have received the first two COVID-19 vaccinations plus three boosters

I have a medical exemption from COVID-19 vaccination

I have chosen to not receive the COVID-19 vaccination

I prefer not to disclose my vaccine status

Unsure of my current vaccine status

Vaccine label(s)

Question Title

* 9. If you have had COVID-19, how many times have you had it?
Once you have answered this question, please hit 'next' to continue the survey.

I have had COVID-19 once

I have had COVID-19 twice

I have had COVID-19 three or more times

I have never had COVID-19

Question Title

* 1. What is your gender?

Question Title

* 2. What is your age?

Question Title

* 3. If you live in Canada, in what province/territory do you reside?

Question Title

* 4. If you do not live in Canada, in what country do you reside?

Question Title

* 5. Please indicate what you consider your “primary” health concern. You will have the opportunity to list other health concerns in the next question.

Question Title

* 6. Please list any other major health concerns you are currently facing, other than what you previously listed as your primary health concern.

Question Title

Question Title

* 8. Have you been vaccinated against COVID-19? If possible, please indicate which brand of vaccine(s) you have received in the comment box.

Question Title

* 9. If you have had COVID-19, how many times have you had it? Once you have answered this question, please hit 'next' to continue the survey.

* 9. If you have had COVID-19, how many times have you had it?
Once you have answered this question, please hit 'next' to continue the survey.