ID

1325

Descripción

SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Baseline Combination Chemotherapy and Bevacizumab in Treating Patients With Locally Advanced, Metastatic, or Recurrent Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BC61E2B0-373A-1037-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BC61E2B0-373A-1037-E034-0003BA12F5E7

Palabras clave

Versiones (2)
  1. 27/8/12 27/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
Subido en

27 de agosto de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00070122 Quality of Life - SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Baseline - 2166850v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Baseline
    1. No Instruction available.
Unnamed1
Descripción

Unnamed1

SWOG Patient ID
Descripción

PatientSouthwestOncologyGroupIdentifierNumber

Tipo de datos

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C25699
UMLS 2011AA Property
C1519429
SWOG Study No.
Descripción

ProtocolSWOGIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C25699
UMLS 2011AA Property
C1519429
Registration Step
Descripción

RegistrationStepNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25646
UMLS 2011AA ObjectClass
C1514821
NCI Thesaurus Property
C16154
UMLS 2011AA Property
C1704379
NCI Thesaurus ValueDomain
C16154
UMLS 2011AA ValueDomain
C1704379
Date
Descripción

FormOriginalCompleteDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C25604
UMLS 2011AA Property
C0205313
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
Patient Initials (L, F M)
Descripción

PatientInitialsName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution/Affiliate
Descripción

CombinedInstitutionName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS 2011AA ObjectClass
C0205195
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
Physician (Groups Other than SWOG)
Descripción

RegisteredInvestigatorName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
NCI Thesaurus ObjectClass
C25644
Group Name
Descripción

ParticipatingGroupName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Study No.
Descripción

ProtocolParticipatingIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Pt. ID
Descripción

PatientParticipatingIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
I believe chemotherapy treatment will take up my time
Descripción

Ibelievechemotherapytreatmentwilltakeupmytime

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe my chemotherapy treatment will take up my family's time
Descripción

Ibelievemychemotherapytreatmentwilltakeupmyfamily'stime

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I worry about side effects from chemotherapy treatment
Descripción

Iworryaboutsideeffectsfromchemotherapytreatment

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe my chemotherapy treatment causes me physical pain
Descripción

Ibelievemychemotherapytreatmentcausesmephysicalpain

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe receiving chemotherapy will be inconvenient
Descripción

Ibelievereceivingchemotherapywillbeinconvenient

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I worry that my chemotherapy will not be effective
Descripción

Iworrythatmychemotherapywillnotbeeffective

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe chemotherapy treatment will be harmful to me
Descripción

Ibelievechemotherapytreatmentwillbeharmfultome

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe my chemotherapy schedule will be stressful to me
Descripción

Ibelievemychemotherapyschedulewillbestressfultome

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe my chemotherapy schedule will be stressful to my family
Descripción

Ibelievemychemotherapyschedulewillbestressfultomyfamily

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I believe I will be bothered by side effects of treatment
Descripción

IbelieveIwillbebotheredbysideeffectsoftreatment

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I am content with the quality of my life right now
Descripción

Iamcontentwiththequalityofmyliferightnow

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Ccrr Module For Southwest Oncology Group S0303 Chemotherapy Convenience And Satisfaction Questionnaire - Baseline
Descripción

Ccrr Module For Southwest Oncology Group S0303 Chemotherapy Convenience And Satisfaction Questionnaire - Baseline

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Baseline
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed1
PatientSouthwestOncologyGroupIdentifierNumber
Item
SWOG Patient ID
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus Property)
C1519429 (UMLS 2011AA Property)
ProtocolSWOGIdentifierNumber
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus Property)
C1519429 (UMLS 2011AA Property)
RegistrationStepNumber
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25646 (NCI Thesaurus ObjectClass)
C1514821 (UMLS 2011AA ObjectClass)
C16154 (NCI Thesaurus Property)
C1704379 (UMLS 2011AA Property)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
FormOriginalCompleteDate
Item
Date
date
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
PatientInitialsName
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
CombinedInstitutionName
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
RegisteredInvestigatorName
Item
Physician (Groups Other than SWOG)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C25644 (NCI Thesaurus ObjectClass)
ParticipatingGroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProtocolParticipatingIdentifierNumber
Item
Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientParticipatingIdentifierNumber
Item
Pt. ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
I believe chemotherapy treatment will take up my time
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.1
Code List
I believe chemotherapy treatment will take up my time
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe my chemotherapy treatment will take up my family's time
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
I believe my chemotherapy treatment will take up my family's time
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I worry about side effects from chemotherapy treatment
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.3
Code List
I worry about side effects from chemotherapy treatment
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe my chemotherapy treatment causes me physical pain
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.4
Code List
I believe my chemotherapy treatment causes me physical pain
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe receiving chemotherapy will be inconvenient
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.5
Code List
I believe receiving chemotherapy will be inconvenient
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I worry that my chemotherapy will not be effective
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.6
Code List
I worry that my chemotherapy will not be effective
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe chemotherapy treatment will be harmful to me
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.7
Code List
I believe chemotherapy treatment will be harmful to me
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe my chemotherapy schedule will be stressful to me
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.8
Code List
I believe my chemotherapy schedule will be stressful to me
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe my chemotherapy schedule will be stressful to my family
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.9
Code List
I believe my chemotherapy schedule will be stressful to my family
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I believe I will be bothered by side effects of treatment
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.10
Code List
I believe I will be bothered by side effects of treatment
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item
I am content with the quality of my life right now
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.11
Code List
I am content with the quality of my life right now
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (a little bit)
CL Item
Somewhat (somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
Item Group
Ccrr Module For Southwest Oncology Group S0303 Chemotherapy Convenience And Satisfaction Questionnaire - Baseline
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