ID

16441

Description

informed consent discussion Melanoma NCT00000000 To be conducted during the first inpatient stay or on the first outpatient visit. Not in the presence oof other patients independent from visit, if possible with reference person. Durchzuführen erstmals während des stationären Aufenthaltes oder beim ersten ambulanten Termin, nicht im Beisein von Mitpatienten, unabhängig von Visite, möglichst mit Bezugsperson

Keywords

Versions (4)
  1. 6/21/16 6/21/16 -
  2. 6/22/16 6/22/16 -
  3. 6/27/16 6/27/16 -
  4. 7/16/16 7/16/16 -
Uploaded on

July 16, 2016

DOI

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License

Creative Commons BY-NC 3.0
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informed consent discussion 1/2 Melanoma NCT00000000

German ( localization.languageCode.DE ) English

Aufklärungsgespräch 1/2 Melanom NCT00000000

1 forms  
Meta Information
Description

Meta Information

Informed Consent discussion conducted with
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Consulting Physician
Description

if Other, please specify

Data type

integer

Alias
UMLS CUI [1]
C1441532
Other Consulting physician
Description

Consulting Physician

Data type

text

Alias
UMLS CUI [1]
C1441532
Date of Informed Consent Discussion
Description

Date of Informed Consent Discussion

Data type

date

Alias
UMLS CUI [1,1]
C0557061
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
Results of investigations complete on the first discussion
Description

In case of missing results please specify. In that case an additional postponed Discussion will be necessary.

Data type

boolean

Alias
UMLS CUI [1,1]
C0582103
UMLS CUI [1,2]
C0205197
Missing Examination results
Description

Missing Examination results

Data type

text

Alias
UMLS CUI [1,1]
C0582103
UMLS CUI [1,2]
C1705492
Discussion participant
Description

In case of Participation of none but the patient themselves: Another discusssion with trusted people participating was suggested and offered.

Data type

integer

Alias
UMLS CUI [1,1]
C0679646
UMLS CUI [1,2]
C0557061
Other Participant
Description

Other Informed Consent Discussion participant

Data type

text

Alias
UMLS CUI [1,1]
C0557061
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0679646
Complete education desired
Description

Complete education desired

Data type

boolean

Alias
UMLS CUI [1,1]
C0030688
UMLS CUI [1,2]
C0205197
UMLS CUI [1,3]
C0871633
Diagnosis and Extent discussed with patient
Description

Diagnosis and Extent discussed

Data type

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0439792
UMLS CUI [1,3]
C0557061
Comment
Description

Comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Also discussed with the patient
Description

Also discussed with the patient

The high malignant potential of the malign melanoma in general. The possibility of present micro metastasis
Description

malignant potential, possibility of micro metastasis

Data type

boolean

Alias
UMLS CUI [1]
C0006826
UMLS CUI [2]
C1513276
already known or presumed Causes (Cancer in general, family predisposition melanocytic neoplasms, exogenic facors (UV-Exposition)
Description

cancer etiology

Data type

boolean

Alias
UMLS CUI [1]
C1516195
Patient's Prognosis ( Mitosis, Lymoh node status, Comorbidity)
Description

Prognosis

Data type

boolean

Alias
UMLS CUI [1]
C0033325
Assignment to risk group
Description

Assignment to risk group

Data type

integer

Alias
UMLS CUI [1]
C0684030
Melanoma currently currently not manifest ( Controlled or in remission)
Description

Melanoma not manifest

Data type

boolean

Alias
UMLS CUI [1,1]
C0205319
UMLS CUI [1,2]
C0025202
Possible limitations caused by cancer, possibly measures for management at home
Description

limitations caused by cancer

Data type

boolean

Alias
UMLS CUI [1,1]
C0449295
UMLS CUI [1,2]
C0006826
possible implications for the desire to have children (family plans) were explained (depending on risk group)
Description

possible implications for the desire to have children

Data type

boolean

Alias
UMLS CUI [1,1]
C0009861
UMLS CUI [1,2]
C1280500
special remarks about porgnosis made
Description

remarks about prognosis

Data type

text

Alias
UMLS CUI [1,1]
C1516221
UMLS CUI [1,2]
C0947611
Patient decree made subject of discussion
Description

The patient or couple should talk to trusted people about arragnements in case of a progression of the disease or any other incident happening to the patient or their partner

Data type

text

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C1283828
patient decree received
Description

patient decree received

Data type

boolean

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C1283828
Psycological counselling offered
Description

obligatory assignment if stage 3 or higher

Data type

integer

Alias
UMLS CUI [1]
C0474178
psychological basic documentation
Description

psychological documentation

Data type

boolean

Alias
UMLS CUI [1,1]
C0205486
UMLS CUI [1,2]
C0920316
Counselling and discussion with social worker (among others about the option of a rehab measure, a disabled person's pass, care and support facilities, social facilities, possibly financial support, home management)
Description

Counselling and discussion with social worker

Data type

integer

Alias
UMLS CUI [1,1]
C0010210
UMLS CUI [1,2]
C0037444
First impression of patient
Description

First impression of patient

Data type

integer

Alias
UMLS CUI [1]
C0596764
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Similar models

Aufklärungsgespräch 1/2 Melanom NCT00000000

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Meta Information
Patient Name
Item
Informed Consent discussion conducted with
text
C1299487 (UMLS CUI [1])
Item
Consulting Physician
integer
C1441532 (UMLS CUI [1])
Consulting Physician
Code List
Consulting Physician
CL Item
Prof Sunderkötter (1)
CL Item
Dr. Weishaupt (2)
CL Item
Prof. Metze (3)
CL Item
Dr. Seller (4)
CL Item
Other (5)
Consulting Physician
Item
Other Consulting physician
text
C1441532 (UMLS CUI [1])
Date of Informed Consent Discussion
Item
Date of Informed Consent Discussion
date
C0557061 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Results of investigations complete
Item
Results of investigations complete on the first discussion
boolean
C0582103 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
Missing Examination results
Item
Missing Examination results
text
C0582103 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
Item
Discussion participant
integer
C0679646 (UMLS CUI [1,1])
C0557061 (UMLS CUI [1,2])
Discussion participant
Code List
Discussion participant
CL Item
Spouse (1)
CL Item
Children (2)
CL Item
Other (3)
CL Item
Only Patient (4)
Other Informed Consent Discussion participant
Item
Other Participant
text
C0557061 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0679646 (UMLS CUI [1,3])
Complete education desired
Item
Complete education desired
boolean
C0030688 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
C0871633 (UMLS CUI [1,3])
Diagnosis and Extent discussed
Item
Diagnosis and Extent discussed with patient
boolean
C0011900 (UMLS CUI [1,1])
C0439792 (UMLS CUI [1,2])
C0557061 (UMLS CUI [1,3])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item Group
Also discussed with the patient
malignant potential, possibility of micro metastasis
Item
The high malignant potential of the malign melanoma in general. The possibility of present micro metastasis
boolean
C0006826 (UMLS CUI [1])
C1513276 (UMLS CUI [2])
cancer etiology
Item
already known or presumed Causes (Cancer in general, family predisposition melanocytic neoplasms, exogenic facors (UV-Exposition)
boolean
C1516195 (UMLS CUI [1])
Prognosis
Item
Patient's Prognosis ( Mitosis, Lymoh node status, Comorbidity)
boolean
C0033325 (UMLS CUI [1])
Item
Assignment to risk group
integer
C0684030 (UMLS CUI [1])
Assignment to risk group
Code List
Assignment to risk group
CL Item
high rist group (1)
CL Item
low risk group (2)
Melanoma not manifest
Item
Melanoma currently currently not manifest ( Controlled or in remission)
boolean
C0205319 (UMLS CUI [1,1])
C0025202 (UMLS CUI [1,2])
limitations caused by cancer
Item
Possible limitations caused by cancer, possibly measures for management at home
boolean
C0449295 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
possible implications for the desire to have children
Item
possible implications for the desire to have children (family plans) were explained (depending on risk group)
boolean
C0009861 (UMLS CUI [1,1])
C1280500 (UMLS CUI [1,2])
remarks about prognosis
Item
special remarks about porgnosis made
text
C1516221 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Patient decree made subject of discussion
Item
Patient decree made subject of discussion
text
C0030705 (UMLS CUI [1,1])
C1283828 (UMLS CUI [1,2])
patient decree received
Item
patient decree received
boolean
C0030705 (UMLS CUI [1,1])
C1283828 (UMLS CUI [1,2])
Item
Psycological counselling offered
integer
C0474178 (UMLS CUI [1])
Psycological counselling offered
Code List
Psycological counselling offered
CL Item
currently desired (1)
CL Item
possibly desired later (2)
CL Item
currently denied (3)
psychological documentation
Item
psychological basic documentation
boolean
C0205486 (UMLS CUI [1,1])
C0920316 (UMLS CUI [1,2])
Item
Counselling and discussion with social worker (among others about the option of a rehab measure, a disabled person's pass, care and support facilities, social facilities, possibly financial support, home management)
integer
C0010210 (UMLS CUI [1,1])
C0037444 (UMLS CUI [1,2])
Counselling and discussion with social worker
Code List
Counselling and discussion with social worker (among others about the option of a rehab measure, a disabled person's pass, care and support facilities, social facilities, possibly financial support, home management)
CL Item
yes, is presumed to take place (1)
CL Item
has taken place (2)
CL Item
no, patient refused at first (3)
Item
First impression of patient
integer
C0596764 (UMLS CUI [1])
First impression of patient
Code List
First impression of patient
CL Item
patient has understood the scope  (1)
CL Item
displaced (2)
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