1 |
Date of birth: _________________ |
District: __________________ |
Province: _________________ |
2 |
Gender |
□ Male |
□ Female |
|
|
3 |
Education |
□ Illiterate |
□ Primary/intermediate |
□ Secondary |
□ University or higher |
4 |
Employment status |
□ Employed |
□ Unemployed |
|
|
Level of information on cancer |
5 |
Do you have information about cancer? |
□ Yes |
□ No |
|
|
If yes, from whom did it come: |
□ The media? |
□ Cultural meetings? |
□ The physician? |
□ The nurses? |
□ A personal experience? |
6 |
Is it possible to recover from cancer? |
□ Yes |
□ No |
|
|
If yes, what is the possibility? |
□ Less than 10% |
□ 10%–50% |
□ More than 50% |
|
7 |
Do you prefer that a patient be told he has cancer? |
□ Yes |
□ No |
□ I do not know |
|
If yes, why? |
□ To better organize their life |
□ To help the course of treatment |
□ To improve the relationship with the family |
□ To avoid living an illusion (know your enemy: knowing the disease makes the patient stronger) |
□ To obtain several medical opinions |
If no, why? |
□ Knowing the truth has a negative effect |
□ To avoid changing everyday life |
□ To avoid pity from others |
□ Because there is no treatment or healing |
8 |
What do you think is the hardest for a cancer patient? |
□ Pain |
□ Fear |
□ Pity of others |
□ Other: ______________________________ |
9 |
Do you think religious faith plays a role in accepting the disease? |
□ Yes |
□ No |
□ I do not know |
|
10 |
Do family and friends play a role in helping the patient to accept the disease? |
□ Yes |
□ No |
□ I do not know |
|
How? |
□ Through moral support |
□ Through material support |
□ Assistance in treatment (choice of hospital, physician, ...) |
□ Help in communicating with the physician |
11 |
In your opinion, what is the most common reaction of the patient when hearing the truth? |
□ Anger |
□ Fear |
□ Perplexity |
□ Acceptance and contentment |
□ Other |
12 |
Are the following factors important and helpful to accept the disease? |
□ Support of friends and family |
□ Relationship between physician and patient |
□ Relationship between patient and nursing staff |
□ Faith |
□ Quality of treatment |
□ Location of treatment |
□ Knowing that the patient will be cured |
13 |
Do you think that the personality of the physician has a positive impact on accepting the disease? |
□ Yes |
□ No |
□ I do not know |
|
How? |
□ Positive psychological influence of the physician |
□ Feeling of conviviality with the physician |
□ Education and knowledge of the physician |
□ Spiritual influence of the physician |
□ All of the above |
14 |
Do you think it is necessary to give patients information about their illness and the results of tests and treatments? |
□ Yes |
□ No |
□ I do not know |
|
□ Sort of |
□ Other |
|
|
When? |
□ Before treatment |
□ During treatment |
□ After treatment |
15 |
Which is easier, dealing with patients who know about their disease or who do not know about their disease? |
□ Knows |
□ Does not know |
|
|
16 |
In your opinion, how many patients know about their disease? |
□ None |
□ Fewer than 50% |
□ More than 50% |
□ All patients |
For patients who know about their disease |
17 |
Who told you the truth? |
□ Physician |
□ Nurses |
□ Parents or friends |
□ Coincidence |
□ Intuition |
18 |
When did you know the diagnosis? |
□ Before treatment |
□ During treatment |
□ After treatment |
19 |
If you knew the truth by yourself, what are the symptoms that pushed you to discover the truth? |
□ Hair loss |
□ Effects on the digestive system |
□ Dry mouth |
□ Feeling tired |
□ Other |
20 |
Do you regret knowing the truth? |
□ Yes |
□ No |
|
|
If yes, why? |
□ Anxiety |
□ Fear |
□ Despair |
□ Other |
If no, why? |
□ Organize life in a better way |
□ Seek multiple medical opinions |
□ Other |
For nurses |
21 |
If patients ask you a question about their treatment and they are unaware of their disease, do you tell them the truth? |
□ Yes |
□ No |
□ I do not know |
|
22 |
If your answer is no, to whom you refer the matter? |
□ The physician |
□ Another nurse who has more experience |
□ A family member |
□ Other: _______________________________ |
For physicians |
23 |
In which stage of disease progression do you prefer to inform the patient about the truth? |
□ Immediately after confirmation of the diagnosis |
□ During treatment |
□ After treatment |
□ At the patient’s request |
24 |
To whom you resort in the first stage to deliver the diagnosis? |
□ Patient |
□ Parents |
□ Friends |
|
25 |
What are the standards adopted in delivering the diagnosis? |
□ Age of the patient |
□ Educational background of the patient |
□ Seriousness of the disease (curable or not) |
□ Stage of the disease |
□ Desire of parents |
□ Faith |
□ Other: ______________________________ |
26 |
What are the obstacles that you encounter when you tell the truth? |
□ Psychosomatic consequences for the patient |
□ Family’s opposition to informing the patient |
□ Fear of not following the treatment |
□ Evasion of the burden of pain |
□ Other |
27 |
Do you tell the patient about the diagnosis? |
□ Directly |
□ Progressively |
|
|
28 |
Do you change the way you interact with the patient depending on the patient’s condition? |
□ Yes |
□ No |
|
|
29 |
Do you tell the whole truth about healing? |
□ In all cases |
□ In some cases (curable, incurable) |
|
|