ID

7322

Beschreibung

SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Experience 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=BC88C25D-EB2A-2B36-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BC88C25D-EB2A-2B36-E034-0003BA12F5E7

Stichworte

Versionen (2)
  1. 27.08.12 27.08.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

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Colorectal Cancer NCT00070122 Quality of Life - SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Experience - 2167428v3.0

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Experience
    1. No Instruction available.
Header
Beschreibung

Header

SWOG Patient ID
Beschreibung

Trial subject ID SWOG

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
SWOG Study No.
Beschreibung

Protocol ID SWOG

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
Registration Step
Beschreibung

Registration Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Assessment
Beschreibung

Assessment

Datentyp

text

Date
Beschreibung

Form Completion Date

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution/Affiliate
Beschreibung

Institution Name

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Physician (Groups Other than SWOG)
Beschreibung

Investigator Name

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2826892
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus ObjectClass-2
C25644
Group Name
Beschreibung

Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Study No.
Beschreibung

Study Number Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Pt. ID
Beschreibung

Trial subject ID Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Chemotherapy treatment takes up my time
Beschreibung

Chemotherapytreatmenttakesupmytime

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Chemotherapy treatment takes up my family's time
Beschreibung

Chemotherapytreatmenttakesupmyfamily'stime

Datentyp

text

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

Iworryaboutsideeffectsfromchemotherapytreatment

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
My chemotherapy treatment causes me physical pain
Beschreibung

Mychemotherapytreatmentcausesmephysicalpain

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Receiving chemotherapy is inconvenient
Beschreibung

Receivingchemotherapyisinconvenient

Datentyp

text

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

Iworrythatmychemotherapywillnotbeeffective

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Chemotherapy treatment seems harmful to me
Beschreibung

Chemotherapytreatmentseemsharmfultome

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
My chemotherapy schedule is stressful to me
Beschreibung

Mychemotherapyscheduleisstressfultome

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
My chemotherapy schedule is stressful to my family
Beschreibung

Mychemotherapyscheduleisstressfultomyfamily

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
I am bothered by side effects of treatment
Beschreibung

PatientAdverseEventAssessmentQualityofLifeScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C41331
UMLS 2011AA Property-2
C0877248
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
I am content with the quality of my life right now
Beschreibung

Iamcontentwiththequalityofmyliferightnow

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Are you satisfied with the current results of your chemotherapy
Beschreibung

Areyousatisfiedwiththecurrentresultsofyourchemotherapy

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Would you recommend this chemotherapy to others with your illness
Beschreibung

Wouldyourecommendthischemotherapytootherswithyourillness

Datentyp

text

Would you choose this chemotherapy again
Beschreibung

Wouldyouchoosethischemotherapyagain

Datentyp

text

How would you rate this chemotherapy
Beschreibung

Howwouldyouratethischemotherapy

Datentyp

text

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

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

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No Instruction available.

1 Formulare
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Experience
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Item
Assessment
text
CL.1
Code List
Assessment
CL Item
Week 7 (Week 7)
CL Item
Week 13 (Week 13)
CL Item
Week 25 (Week 25)
Form Completion Date
Item
Date
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
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)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Investigator Name
Item
Physician (Groups Other than SWOG)
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
Participating Group
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Pt. ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item
Chemotherapy treatment takes up my time
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
Chemotherapy treatment takes 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
Chemotherapy treatment takes up my family's time
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.3
Code List
Chemotherapy treatment takes 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.4
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
My chemotherapy treatment causes me physical pain
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.5
Code List
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
Receiving chemotherapy is inconvenient
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.6
Code List
Receiving chemotherapy is 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.7
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
Chemotherapy treatment seems harmful to me
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.8
Code List
Chemotherapy treatment seems 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
My chemotherapy schedule is stressful to me
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.9
Code List
My chemotherapy schedule is 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
My chemotherapy schedule is stressful to my family
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.10
Code List
My chemotherapy schedule is 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 am bothered by side effects of treatment
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41331 (NCI Thesaurus Property-2)
C0877248 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
I am bothered by side effects of treatment
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
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)
C91216 (NCI Thesaurus-2)
CL Item
Very Much (very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
Item
I am content with the quality of my life right now
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.12
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
Are you satisfied with the current results of your chemotherapy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.13
Code List
Are you satisfied with the current results of your chemotherapy
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
Would you recommend this chemotherapy to others with your illness
text
CL.14
Code List
Would you recommend this chemotherapy to others with your illness
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
Maybe (maybe)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Would you choose this chemotherapy again
text
CL.15
Code List
Would you choose this chemotherapy again
CL Item
Not At All (not at all)
C91213 (NCI Thesaurus)
CL Item
Maybe (maybe)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
How would you rate this chemotherapy
text
CL.16
Code List
How would you rate this chemotherapy
CL Item
Poor (poor)
CL Item
Fair (fair)
CL Item
Good (good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (very good)
CL Item
Excellent (excellent)
Item Group
Ccrr Module For Southwest Oncology Group S0303 Chemotherapy Convenience And Satisfaction Questionnaire - Experience
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