Cancer Survivorship Survey for Northwest Tribal Healthcare Providers and Cancer Prevention Advocates
The Northwest Tribal Comprehensive Cancer Program appreciates your responses.
Your feedback is invaluable in guiding our work to support cancer-free Tribal communities.
Your answers are anonymous.
1.
Where do you work?
A Tribal healthcare facility
Within a Tribal community
Urban Indian Health Organization
Other (please specify)
2.
What is your professional title?
Behavioral Health Specialist
Behavioral Health Specialist
Certified Nurse Midwife
Certified Nursing Assistant
Certified Registered Nurse Anesthetist
Dental Hygienist
Dentist
Licensed Vocational Nurse/Licensed Practical Nurse
Medical Assistant
Medical Doctor/Doctor of Osteopathy
Nurse Practitioner
Patient Navigator
Peer Specialist
Peer Specialist
Pharmacist
Physician Assistant
Registered Dietitian
Registered Nurse
Tobacco Prevention Coordinator
Tribal health educator
Other (please specify)
3.
What is your role in cancer prevention and control within your community/clinic?
4.
If a patient has an abnormal cancer screening result, what step do you usually take next?
Repeat the test
Refer for diagnostic testing
Other (please specify)
5.
What cancer treatment center do you refer cancer patients to?
6.
What are the most common cancers that you see in your practice? Please select the top 3
Breast
Colorectal
Gynecologic
Liver
Lung
Prostate
Other (please specify)
7.
How do you receive information about the care a patient referred for cancer treatment receives? (select all that apply)
Oncologist sends written survivorship care plan
Patient provides written survivorship care plan
Request cancer treatment information from provider
Patient verbally shares cancer treatment information
Don’t usually receive information
Other (please specify)
8.
How do you promote cancer screenings in your clinic? (select all that apply)
Our providers suggest patients get cancer screening during clinic visits
Our staff let patients know that they are due for cancer screenings
Distribute flyers in community (health fairs, library, etc.)
Newspaper
Magazine
Radio
Television
Social media
Other (please specify)
9.
Please rank the resources our program can provide for increasing cancer screening in your patients from most helpful to least helpful
Not at all helpful
Somewhat helpful
Moderately helpful
Very helpful
Extremely helpful
Technical assistance and training on cancer interventions that work
Data that describes the burden of cancer
Bringing people together to talk about how we can decrease the burden of cancer
Providing seed money to implement interventions in the cancer plan
Ensuring that we have an up-to-date and comprehensive cancer plan
Providing resources like cancer ads and posters
Providing cancer training with CMEs
Survivorship care visit checklist
Other (please specify)
10.
To what extent are you familiar with the following community resources that support survivorship initiatives?
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Completely familiar
Cancer survivor support group
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Completely familiar
Tobacco cessation program
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Completely familiar
CHW or patient navigators that help cancer survivors navigate
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Completely familiar
Nutrition and physical activity information for survivors
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Completely familiar
Other (please specify)
11.
What do you think is needed the most to support cancer survivors in your community?
12.
Are EHR records being used to populate some of the data needed for cancer survivor care plans?
Yes
No
Other (please specify)
13.
If your clinic has a patient navigator:
What type of training do you think your patient navigator(s) could benefit from?
14.
To what extent are you satisfied with the care that your patients with cancer receive?
Not at all satisfied
Slightly satisfied
Moderately satisfied
Very satisfied
Completely satisfied
Please explain why you chose the selection above.
15.
If you ordered NTCCP Cancer survivor kits; how many did you order, how many survivors received kits in your tribe, and how did you distribute them? Did you receive any feedback from the survivors?
16.
Please feel free to provide additional information here:
