ID

7322

Description

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

Lien

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

Mots-clés

  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

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

No Instruction available.

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

Header

SWOG Patient ID
Description

Trial subject ID SWOG

Type de données

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.
Description

Protocol ID SWOG

Type de données

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
Description

Registration Number

Type de données

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
Description

Assessment

Type de données

text

Date
Description

Form Completion Date

Type de données

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)
Description

Patient Initials

Type de données

text

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

Institution Name

Type de données

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)
Description

Investigator Name

Type de données

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
Description

Participating Group

Type de données

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.
Description

Study Number Participating Group

Type de données

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
Description

Trial subject ID Participating Group

Type de données

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
Description

Chemotherapytreatmenttakesupmytime

Type de données

text

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

Chemotherapytreatmenttakesupmyfamily'stime

Type de données

text

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

Iworryaboutsideeffectsfromchemotherapytreatment

Type de données

text

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

Mychemotherapytreatmentcausesmephysicalpain

Type de données

text

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

Receivingchemotherapyisinconvenient

Type de données

text

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

Iworrythatmychemotherapywillnotbeeffective

Type de données

text

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

Chemotherapytreatmentseemsharmfultome

Type de données

text

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

Mychemotherapyscheduleisstressfultome

Type de données

text

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

Mychemotherapyscheduleisstressfultomyfamily

Type de données

text

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

PatientAdverseEventAssessmentQualityofLifeScale

Type de données

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
Description

Iamcontentwiththequalityofmyliferightnow

Type de données

text

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

Areyousatisfiedwiththecurrentresultsofyourchemotherapy

Type de données

text

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

Wouldyourecommendthischemotherapytootherswithyourillness

Type de données

text

Would you choose this chemotherapy again
Description

Wouldyouchoosethischemotherapyagain

Type de données

text

How would you rate this chemotherapy
Description

Howwouldyouratethischemotherapy

Type de données

text

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

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

Similar models

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0303 Chemotherapy Convenience and Satisfaction Questionnaire - Experience
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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
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
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
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

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial