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