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ID

11417

Descrição

NCT00075686 COVERSHEET FOR PATIENT-COMPLETE QUESTIONNAIRES: S0205 S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B186CE8D-98A1-0591-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B186CE8D-98A1-0591-E034-0003BA12F5E7

Palavras-chave

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 03/07/2015 03/07/2015 -
Transferido a

3 de julho de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy

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    NCT00075686 COVERSHEET FOR PATIENT-COMPLETE QUESTIONNAIRES: S0205

    No Instruction available.

    1. StudyEvent: COVERSHEET FOR PATIENT-COMPLETE QUESTIONNAIRES: S0205
      1. No Instruction available.
    Header
    Descrição

    Header

    SWOG Patient ID
    Descrição

    SWOGPatientID

    Tipo de dados

    text

    SWOG Study No.
    Descrição

    SWOGStudyNo.

    Tipo de dados

    text

    Registration Step
    Descrição

    RegistrationStep

    Tipo de dados

    text

    Patient Initials (L, F M)
    Descrição

    Patient Initials

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Planned Assessment
    Descrição

    Planned Assessment

    Tipo de dados

    text

    Institution/Affiliate
    Descrição

    MainMemberInstitution/Affiliate

    Tipo de dados

    text

    DATE
    Descrição

    FormCompletionDate,Original

    Tipo de dados

    date

    Physician
    Descrição

    RegisteredInvestigator

    Tipo de dados

    text

    BY
    Descrição

    PersonCompletingForm,LastName

    Tipo de dados

    text

    PHONE
    Descrição

    PersonCompletingForm,Phone

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    Miscellaneous Patient Information
    Descrição

    Miscellaneous Patient Information

    Was the Pain Medication Log completed?
    Descrição

    PainPersonalLogCompleteInd-3

    Tipo de dados

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus ObjectClass
    C3303
    UMLS 2011AA ObjectClass
    C0030193
    NCI Metathesaurus ObjectClass
    C0872075
    Was the Brief Pain Inventory completed?
    Descrição

    WastheBriefPainInventorycompleted?

    Tipo de dados

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Was the LASA Patient Quality of Life Questionnaire completed?
    Descrição

    WastheLASAPatientQualityofLifeQuestionnairecompleted?

    Tipo de dados

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    If Completed, In general did the patient require assistance?
    Descrição

    Ifcompleted,ingeneral,didthepatientrequireassistance?

    Tipo de dados

    boolean

    Describe (If Yes,)
    Descrição

    Describe

    Tipo de dados

    text

    If Completed, Questionnaire administered
    Descrição

    PatientQuestionnaireAdministeredMethodType

    Tipo de dados

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C17048
    UMLS 2011AA ObjectClass-2
    C0034394
    NCI Thesaurus Property
    C16847
    UMLS 2011AA Property
    C0449851
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Other (please specify)
    Descrição

    PatientQuestionnaireAdministeredMethodSpecify

    Tipo de dados

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C17048
    UMLS 2011AA ObjectClass-2
    C0034394
    NCI Thesaurus Property
    C16847
    UMLS 2011AA Property
    C0449851
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    If Not completed, Please give reason (select one)
    Descrição

    Incomplete documentation, reason

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1548386
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C0566251
    NCI Metathesaurus Property
    C0034394
    Other (specify)
    Descrição

    Other(specify)

    Tipo de dados

    text

    Ccrr Module For Coversheet For Patient-complete Questionnaires: S0205
    Descrição

    Ccrr Module For Coversheet For Patient-complete Questionnaires: S0205

    Similar models

    No Instruction available.

    1. StudyEvent: COVERSHEET FOR PATIENT-COMPLETE QUESTIONNAIRES: S0205
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    Alias
    Item Group
    Header
    SWOGPatientID
    Item
    SWOG Patient ID
    text
    SWOGStudyNo.
    Item
    SWOG Study No.
    text
    RegistrationStep
    Item
    Registration Step
    text
    Patient Initials
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Item
    Planned Assessment
    text
    Code List
    Planned Assessment
    CL Item
    Prestudy (Prestudy)
    CL Item
    Week 5 (Week 5)
    CL Item
    Week 9 (Week 9)
    CL Item
    Week 13 (Week 13)
    CL Item
    Week 17 (Week 17)
    MainMemberInstitution/Affiliate
    Item
    Institution/Affiliate
    text
    FormCompletionDate,Original
    Item
    DATE
    date
    RegisteredInvestigator
    Item
    Physician
    text
    PersonCompletingForm,LastName
    Item
    BY
    text
    PersonCompletingForm,Phone
    Item
    PHONE
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    Item Group
    Miscellaneous Patient Information
    PainPersonalLogCompleteInd-3
    Item
    Was the Pain Medication Log completed?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus ObjectClass)
    C0030193 (UMLS 2011AA ObjectClass)
    C0872075 (NCI Metathesaurus ObjectClass)
    WastheBriefPainInventorycompleted?
    Item
    Was the Brief Pain Inventory completed?
    boolean
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    WastheLASAPatientQualityofLifeQuestionnairecompleted?
    Item
    Was the LASA Patient Quality of Life Questionnaire completed?
    boolean
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    Ifcompleted,ingeneral,didthepatientrequireassistance?
    Item
    If Completed, In general did the patient require assistance?
    boolean
    Describe
    Item
    Describe (If Yes,)
    text
    Item
    If Completed, Questionnaire administered
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus ObjectClass-2)
    C0034394 (UMLS 2011AA ObjectClass-2)
    C16847 (NCI Thesaurus Property)
    C0449851 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    If Completed, Questionnaire administered
    CL Item
    In The Clinic (In the clinic)
    CL Item
    By Telephone (By telephone)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientQuestionnaireAdministeredMethodSpecify
    Item
    Other (please specify)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus ObjectClass-2)
    C0034394 (UMLS 2011AA ObjectClass-2)
    C16847 (NCI Thesaurus Property)
    C0449851 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Item
    If Not completed, Please give reason (select one)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1548386 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C0034394 (NCI Metathesaurus Property)
    Code List
    If Not completed, Please give reason (select one)
    CL Item
    Illness/deteriorating Health (Illness/deteriorating health)
    CL Item
    Not Illness Related (Not illness related)
    CL Item
    Institution Error (Institution error)
    CL Item
    Death (Death)
    C28554 (NCI Thesaurus)
    C0011065 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Other(specify)
    Item
    Other (specify)
    text
    Item Group
    Ccrr Module For Coversheet For Patient-complete Questionnaires: S0205

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