Tele-Education Session Satisfaction Survey s1

¡Vida! Educational Series

Update on Breast Cancer

September 13, 2012 Location: ______

General Information Survey

1- I am a: (please circle all that apply) Other ______Breast cancer survivor Relative of a breast cancer survivor Caregiver of a breast cancer survivor CPG (Community Partner Group) Lay health worker/ promoter Health care professional______2- My residence is in city/town: ______county: ______zip code: ______3- My health insurance is: (please circle all that apply) AHCCCS PCAP Private (please specify) (HMO/ PPO) ______Other______No health insurance Medicare ______4- Age ______Gender ______5- Race/ Ethnicity: (please circle all that apply) Native American Pacific Islander Caucasian Mixed race Asian African American Other ______6- How did you hear about this session? ______7- As a result of viewing this presentation, will you? (circle all that apply): Seek medical care Yes No Share the information with others, if yes, who:______Yes No Change your practice Yes No Other: ______Before viewing the session: My knowledge about this topic is: (circle only one answer) none at all very little somewhat a lot

Please answer these questions before viewing this session: A-An example of targeted therapy for breast cancer is: chemotherapy radiation therapy trastuzumab surgery

B- Benefit of chemotherapy is best predicted by: Estrogen sensitivity Progesterone sensitivity Normal MammaPrint results High risk Oncotype DX results

C- Radiation therapy: circle all that apply improves survival after breast cancer decreases breast cancer recurrence locally prevents distant metastases always produces radiation pneumonitis

______After viewing the session: My knowledge about this topic is: (circle only one answer) 1 ¡Vida! Educational Series

none at all very little somewhat a lot

Please answer these questions after viewing this session:

A-An example of targeted therapy for breast cancer is: chemotherapy radiation therapy trastuzumab surgery

B- Benefit of chemotherapy is best predicted by: Estrogen sensitivity Progesterone sensitivity Normal MammaPrint results High risk Oncotype DX results

C- Radiation therapy: circle all that apply improves survival after breast cancer decreases breast cancer recurrence locally prevents distant metastases always produces radiation pneumonitis

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AFTER VIEWING THE SESSION PLEASE COMPLETE THIS SURVEY

Sponsored by the University of Arizona College of Medicine at the Arizona Health Sciences Center

ATP – CLINICAL CARE CONFERENCE SERIES GRAND ROUNDS TEACHING EVALUATION

YOUR NAME (please print): DEGREE / JOB TITLE:

TODAY’S DATE: 9/13/12 ARIZONA TELEMEDICINE PROGRAM SITE AFFILIATION:

STATUS: STUDENT  FELLOW  FACULTY  HOUSE OFFICER  OTHER 

PROGRAM TITLE: Update on Breast Cancer SPEAKER: Ana Maria Lopez, MD,MPH,FACP

STRONGL NO STRONGL Y DISAGREE OPINION AGREE Y DISAGREE AGREE

This topic is of interest to me 1 2 3 4 5 This topic is relevant to my practice and will ultimately improve patient 1 2 3 4 5 care

I learned new information 1 2 3 4 5 The teaching techniques were conducive to learning 1 2 3 4 5 The speaker was prepared and informative 1 2 3 4 5 The educational objectives were met 1 2 3 4 5 I would not have been able to attend a lecture on this topic if it had not 1 2 3 4 5 been available via the ATP

What other topics would you like to see addressed?

Did you feel there was a bias toward any particular product or company? Yes____ NO _____ If yes, please explain:

COMMENTS:

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THANK YOU

You may submit the completed forms in any of the following ways:

Via fax: (520) 626- 6252 Attn: Bettina Hofacre

Via mail: University of Arizona Cancer Center Attn: Bettina Hofacre 1515 N. Campbell Ave Tucson, AZ 85724

Via e-mail to: [email protected]

If you have any questions please contact:

Bettina Hofacre at (520) 626-3265