ID
10082
Descrizione
CALGB: SOCIAL SUPPORT FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50BF99D-12AE-2D64-E034-080020C9C0E0
collegamento
Keywords
versioni (2)
- 18/12/14 18/12/14 - Martin Dugas
- 23/03/15 23/03/15 - Martin Dugas
Caricato su
23 marzo 2015
DOI
Per favore, per richiedere un accesso.
Licenza
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Descrizione
Social support
Alias
- UMLS CUI-1
- C0037438
Descrizione
Abouthowmanyclosefriendsandcloserelativesdoyouhavenow(peopleyoufeelateasewithandcantalktoaboutwhatisonyourmind)?
Tipo di dati
integer
Alias
- UMLS CUI-1
- C0079382
- UMLS CUI-2
- C0449788
Descrizione
Someonetohelpifyouwereconfinedtobed
Tipo di dati
text
Descrizione
Someoneyoucancountontolistentoyouwhenyouneedtotalk
Tipo di dati
text
Descrizione
Someonetogiveyougoodadviceaboutacrisis
Tipo di dati
text
Descrizione
Someonetotakeyoutothedoctorifyouneededit
Tipo di dati
text
Descrizione
Someonewhoshowsyouloveandaffection
Tipo di dati
text
Descrizione
Someonetohaveagoodtimewith
Tipo di dati
text
Descrizione
Someonetogiveyouinformationtohelpyouunderstandasituation
Tipo di dati
text
Descrizione
Someonetoconfideinortalktoaboutyourselforyourproblems
Tipo di dati
text
Descrizione
Someone who hugs you (11.)
Tipo di dati
text
Descrizione
Someonetogettogetherwithforrelaxation
Tipo di dati
text
Descrizione
Someone to prepare your meals if you were unable to do it yourself (13.)
Tipo di dati
text
Descrizione
Someone whose advice you really want (14.)
Tipo di dati
text
Descrizione
Someone to do things with to help you get your mind off things (15.)
Tipo di dati
text
Descrizione
Someone to help you with daily chores if you were sick (16.)
Tipo di dati
text
Descrizione
Someone to share your most private worries and fears with (17.)
Tipo di dati
text
Descrizione
Someone to turn to for suggestions about how to deal with a personal problem (18.)
Tipo di dati
text
Descrizione
Someone to do something enjoyable with (19.)
Tipo di dati
text
Descrizione
Someone who understands your problems (20.)
Tipo di dati
text
Descrizione
Someone to love and make you feel wanted
Tipo di dati
text
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0449788 (UMLS CUI-2)