Table 1.

Items composing the area scales for the Patient’s Perceived Quality of Care survey.

Area	Item Description
Administrative Services: Please select a rating from 1 = Very Poor to 7 = Excellent for each of the following items based on today’s visit to the clinic.
	Appointment scheduling*
	Locating clinic/checking in, checking out, parking, etc.*
Clinical Services: Please select a rating from 1 = Very Poor to 7 = Excellent for each of the following items based on today’s visit to the clinic.
	Your medical concerns*
	Your psychological and/or social concerns*
	Your sexual well-being
	Your health risk factors, like smoking or weight
	Your need for a referral to another medical provider
Educational Services: Please select a rating from 1 = Very Poor to 7 = Excellent for each of the following items based on today’s visit to the clinic. Mark “None Received” if no materials were received.
	Your cancer and the treatment you have received
	The short term effects of your cancer treatment
	Strategies to monitor or manage the short term effects of cancer treatment
	The long term effects of your cancer treatment*
	Strategies to monitor or manage the long term effects of cancer treatment*
	Strategies for reducing risk, such as changing health habits or behaviors
	Other resources available to you at the clinic or at the medical center
Helpfulness of Written Materials: Please select a rating from 1 = Very Poor to 7 = Excellent for the helpfulness of written materials (care plans, booklets, etc.) you have received from this clinic (or mark “None Received” if no materials were received) regarding…
	Your cancer
	Cancer treatments you have had
	Coordinating your own care
	Risk of a second cancer
	Fatigue (as applicable)
	Surgical procedures and side effects (as applicable)
	Chemotherapy procedures and side effects (as applicable)
	Radiation procedures and side effects (as applicable)
	Other treatment procedures and side effects (as applicable)

^*Item adapted from Perceptions of Quality of Care survey provided by the Jonsson Comprehensive Cancer Center at UCLA.