1) |
Are you a full-time pediatric urologist? |
Yes ❏ No ❏ |
|
2) |
Which province and city do you practice in? |
Province___________________ City___________________ |
|
3) |
What year did you begin practicing? |
Year______________ |
|
4) |
Do you have a transition process for SB patients from adolescence to adulthood in place in your centre? |
Yes ❏ No ❏ |
|
5) |
Do you personally provide the ongoing urological care for SB patients after their transition from pediatric care? |
Yes ❏ No ❏ |
|
6) |
Do you have an identified recipient adult or transitional urologist in your community to care for adult SB patients? |
Yes ❏ No ❏ |
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7) |
Is sexual function formally discussed with your male and female SB patients as part of transition? |
Yes ❏ No ❏ |
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8) |
Is pregnancy, as well as birth control, discussed with female SB patients as part of transition? |
Yes ❏ No ❏ |
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9) |
Do you feel transition adult clinics should be the norm and parallel the pediatric multidisciplinary clinics (as opposed to having a single-specialty provider)? |
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10) |
Do you utilize a questionnaire or a checklist to determine transition readiness of patients? |
Yes ❏ No ❏ |
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11) |
At what age should the transition process begin, in general, for SB patients? |
Age _____________ |
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12) |
If you are a pediatric urologist, do you encourage patients to attend appointments independent of their parents as they grow older? |
Yes ❏ No ❏ |
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13) |
If you answered ‘yes’ to question 12, at what age do you encourage patients to attend appointments independent of their parents? |
Age _____________ |
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14) |
What are other diagnoses besides SB where transition might be contemplated for ideal urological care? |