ID
10082
Descrição
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
Link
Palavras-chave
Versões (2)
- 18/12/2014 18/12/2014 - Martin Dugas
- 23/03/2015 23/03/2015 - Martin Dugas
Transferido a
23 de março de 2015
DOI
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Licença
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.
Descrição
Social support
Alias
- UMLS CUI-1
- C0037438
Descrição
Abouthowmanyclosefriendsandcloserelativesdoyouhavenow(peopleyoufeelateasewithandcantalktoaboutwhatisonyourmind)?
Tipo de dados
integer
Alias
- UMLS CUI-1
- C0079382
- UMLS CUI-2
- C0449788
Descrição
Someonetohelpifyouwereconfinedtobed
Tipo de dados
text
Descrição
Someoneyoucancountontolistentoyouwhenyouneedtotalk
Tipo de dados
text
Descrição
Someonetogiveyougoodadviceaboutacrisis
Tipo de dados
text
Descrição
Someonetotakeyoutothedoctorifyouneededit
Tipo de dados
text
Descrição
Someonewhoshowsyouloveandaffection
Tipo de dados
text
Descrição
Someonetohaveagoodtimewith
Tipo de dados
text
Descrição
Someonetogiveyouinformationtohelpyouunderstandasituation
Tipo de dados
text
Descrição
Someonetoconfideinortalktoaboutyourselforyourproblems
Tipo de dados
text
Descrição
Someone who hugs you (11.)
Tipo de dados
text
Descrição
Someonetogettogetherwithforrelaxation
Tipo de dados
text
Descrição
Someone to prepare your meals if you were unable to do it yourself (13.)
Tipo de dados
text
Descrição
Someone whose advice you really want (14.)
Tipo de dados
text
Descrição
Someone to do things with to help you get your mind off things (15.)
Tipo de dados
text
Descrição
Someone to help you with daily chores if you were sick (16.)
Tipo de dados
text
Descrição
Someone to share your most private worries and fears with (17.)
Tipo de dados
text
Descrição
Someone to turn to for suggestions about how to deal with a personal problem (18.)
Tipo de dados
text
Descrição
Someone to do something enjoyable with (19.)
Tipo de dados
text
Descrição
Someone who understands your problems (20.)
Tipo de dados
text
Descrição
Someone to love and make you feel wanted
Tipo de dados
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)