!Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine
HCP Session 9: Approaches to Pain Management – Breast Cancer Date: ______Location: ______General Information Survey
BEFORE VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY Instructions: Please circle the correct answer/s:
1- I attended/viewed this session: Via videoconference In-person Via internet DVD/ VHS
2- I am a: Please circle all that apply: Breast cancer survivor (anyone with a diagnosis of breast cancer) Relative of a breast cancer survivor Lay health worker/ promotor(a) Caregiver of a breast cancer survivor CPG (Community Partner Group member – assisted in project development) Health care provider (please specify) ______Other ______
3- My place of residence is in the following city/town/ rural area ______
4- The following describe me: Age ______Gender ______
5- I describe my ethnicity as: Hispanic Non-Hispanic
6- I describe my race as: White American Indian Pacific Islander Asian Other (please specify) ______
7- The highest grade of school that I completed is ______
8-At home, I speak: English only Spanish only English & Spanish Other (please specify ______
9- I needed this presentation translated into Spanish: Yes No
10- I heard abut this session from ______
11- I attended a Vida session before? No Yes If yes, this is my #1, #2, #3, #4, #5, #6,#7, #8, #9 Vida session attended
Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 1 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine
¡Vida! Pre- Knowledge Assessment Survey BEFORE VIEWING THE SESSION, PLEASE COMPLETE THIS SUVEY HCP Session 9: Approaches to Pain Management – Breast Cancer Instructions: Please read the following questions and provide the best answer: 1) My knowledge about this topic is: (circle the best answer) none at all very little somewhat a lot 2) Which one of the following is a predictor of chronic post-treatment breast pain?
a) Length of the surgical procedure
b) Intensity of peri-operative acute pain
c) Duration of hospital stay
3) Post Mastectomy Pain Syndrome involves:
a) Phantom breast pain
b) Intercostobrachial neuralgia
c) Neuroma pain
d) All of the above
4) The Intercostobrachial nerve arises from:
a) The first intercostals nerve
b) The second intercostals nerve
c) The third intercostals nerve
d) The fourth intercostals nerve
5) Neuropathic pain may involve:
a) Paresthesia
b) Dysesthesia
c) Allodynia
d) Hyperalgesia
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e) All of the above
6) Phantom Breast Pain is:
a) A referred pain
b) Develops weeks after the procedure
c) The same thing as Phantom Breast sensation.
d) Phantom Breast pain has a good prognosis.
PLEASE DO NOT COMPLETE ANY ADDITIONAL FORMS UNTIL AFTER YOU HAVE VIEWED THE ENTIRE PRESENTATION
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PLEASE PROCEED AND VIEW
THE VIDA! PRESENTATION
Educational Objectives for this Session
1- Discuss the etiology of neuropathic pain in breast cancer survivors 2- Describe the multidisciplinary approach to pain management assessment and treatment 3- Outline the appropriate use of pain evaluation tools
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Session Satisfaction Survey
STRONGLY NO STRONGLY DISAGREE DISAGREE OPINION AGREE AGREE 1- Videoconferencing, DVD/ VHS, attending via internet made my 1 2 3 4 5 attendance possible 2 -I was able to speak freely and ask questions. 1 2 3 4 5
3- I learned new information. 1 2 3 4 5 4- The teaching techniques were conducive to learning. 1 2 3 4 5 5- The information presented was appropriate for my needs. 1 2 3 4 5 6- The handouts were useful for the session. 1 2 3 4 5 7- The educational objectives were met. 1 2 3 4 5 8- The speaker was prepared and informative. 1 2 3 4 5 9- I was comfortable with the camera and other equipment. 1 2 3 4 5 10- I was able to hear questions from the other locations. 1 2 3 4 5 11- I had no trouble hearing the presenter. 1 2 3 4 5 12- I could see the presenter clearly during the session. 1 2 3 4 5 13- My experience was as good as seeing the speaker face to face. 1 2 3 4 5 14- Overall, I am satisfied with this training. 1 2 3 4 5
AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY
The information you have provided will help to increase our body of knowledge about how well this educational session has met your needs and expectations
Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 5 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine
¡Vida! Post-Knowledge Assessment Survey AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY HCP Session 9: Approaches to Pain Management – Breast Cancer
Instructions: Please read the following questions and provide the best answer:
1) After watching this presentation, my knowledge about this topic is: (circle the best answer) none at all very little somewhat a lot
2) Which one of the following is a predictor of chronic post-treatment breast pain?
a) Length of the surgical procedure
b) Intensity of peri-operative acute pain
c) Duration of hospital stay
3) Post Mastectomy Pain Syndrome involves:
a) Phantom breast pain
b) Intercostobrachial neuralgia
c) Neuroma pain
d) All of the above
4) The Intercostobrachial nerve arises from:
a) The first intercostals nerve
b) The second intercostals nerve
c) The third intercostals nerve
d) The fourth intercostals nerve
5) Neuropathic pain may involve:
a) Paresthesia
b) Dysesthesia
c) Allodynia
d) Hyperalgesia
Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 6 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine
e) All of the above
6) Phantom Breast Pain is:
a) A referred pain
b) Develops weeks after the procedure
c) The same thing as Phantom Breast sensation.
d) Phantom Breast pain has a good prognosis.
Thank you very much for taking the time to complete all study forms
You may submit the completed forms in any of the following ways:
Via fax: (520) 626-2225 ATTN: Angela or
Via mail : Arizona Cancer Center ATTN: Angela Valencia 1515 N. Campbell Ave Tucson, AZ 85724 or Via e-mail to: [email protected]
If you nave any questions please call: (520) 626-3265 Bettina Hofacre
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