Description:

E3201 Patient Bowel Function/Uniscale Questionnaire NCT00068692 Comparison of Adjuvant Chemotherapy Regimens in Treating Patients With Stage II or Stage III Rectal Cancer Who Are Receiving Radiation Therapy and Fluorouracil Before or After Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B552120F-3E84-6D21-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B552120F-3E84-6D21-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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E3201 Patient Bowel Function/Uniscale Questionnaire NCT00068692

No Instruction available.

  1. StudyEvent: E3201 Patient Bowel Function/Uniscale Questionnaire
    1. No Instruction available.
Header
Time Period (Group 1)
Time Period (Group 2)
Patient Bowel Function
Are data amended?
Overall, would you say that you had problems with your bowel function in the last week?
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
In the past week, have you had a problem causing you to lose control of your bowel movements?
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
In the past week, have you had a problem causing you to have stools that are liquid?
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
In the past week, have you had cramping with a bowel movement?
Is your cramping
In the past week, have you had blood in your bowel movement?
Check the description that best describes the amount of blood in your bowel movement
In the past week, how much have problems with bowel movements affected your normal activities?
Ccrr Module For E3201 Patient Bowel Function/uniscale Questionnaire

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