<p> !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p>HCP Session 9: Approaches to Pain Management – Breast Cancer Date: ______Location: ______General Information Survey </p><p>BEFORE VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY Instructions: Please circle the correct answer/s:</p><p>1- I attended/viewed this session: Via videoconference In-person Via internet DVD/ VHS</p><p>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 ______</p><p>3- My place of residence is in the following city/town/ rural area ______</p><p>4- The following describe me: Age ______Gender ______</p><p>5- I describe my ethnicity as: Hispanic Non-Hispanic</p><p>6- I describe my race as: White American Indian Pacific Islander Asian Other (please specify) ______</p><p>7- The highest grade of school that I completed is ______</p><p>8-At home, I speak: English only Spanish only English & Spanish Other (please specify ______</p><p>9- I needed this presentation translated into Spanish: Yes No</p><p>10- I heard abut this session from ______</p><p>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</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 1 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p>¡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?</p><p> a) Length of the surgical procedure</p><p> b) Intensity of peri-operative acute pain</p><p> c) Duration of hospital stay</p><p>3) Post Mastectomy Pain Syndrome involves:</p><p> a) Phantom breast pain</p><p> b) Intercostobrachial neuralgia</p><p> c) Neuroma pain</p><p> d) All of the above</p><p>4) The Intercostobrachial nerve arises from:</p><p> a) The first intercostals nerve</p><p> b) The second intercostals nerve</p><p> c) The third intercostals nerve</p><p> d) The fourth intercostals nerve</p><p>5) Neuropathic pain may involve:</p><p> a) Paresthesia</p><p> b) Dysesthesia</p><p> c) Allodynia</p><p> d) Hyperalgesia</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 2 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p> e) All of the above</p><p>6) Phantom Breast Pain is:</p><p> a) A referred pain</p><p> b) Develops weeks after the procedure</p><p> c) The same thing as Phantom Breast sensation.</p><p> d) Phantom Breast pain has a good prognosis.</p><p>PLEASE DO NOT COMPLETE ANY ADDITIONAL FORMS UNTIL AFTER YOU HAVE VIEWED THE ENTIRE PRESENTATION</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 3 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p>PLEASE PROCEED AND VIEW </p><p>THE VIDA! PRESENTATION</p><p>Educational Objectives for this Session</p><p>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</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 4 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p>Session Satisfaction Survey</p><p>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</p><p>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</p><p>AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY</p><p>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</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 5 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p>¡Vida! Post-Knowledge Assessment Survey AFTER VIEWING THE SESSION, PLEASE COMPLETE THIS SURVEY HCP Session 9: Approaches to Pain Management – Breast Cancer </p><p>Instructions: Please read the following questions and provide the best answer:</p><p>1) After watching this presentation, my knowledge about this topic is: (circle the best answer) none at all very little somewhat a lot</p><p>2) Which one of the following is a predictor of chronic post-treatment breast pain?</p><p> a) Length of the surgical procedure</p><p> b) Intensity of peri-operative acute pain</p><p> c) Duration of hospital stay</p><p>3) Post Mastectomy Pain Syndrome involves:</p><p> a) Phantom breast pain</p><p> b) Intercostobrachial neuralgia</p><p> c) Neuroma pain</p><p> d) All of the above</p><p>4) The Intercostobrachial nerve arises from:</p><p> a) The first intercostals nerve</p><p> b) The second intercostals nerve</p><p> c) The third intercostals nerve</p><p> d) The fourth intercostals nerve</p><p>5) Neuropathic pain may involve:</p><p> a) Paresthesia</p><p> b) Dysesthesia</p><p> c) Allodynia</p><p> d) Hyperalgesia</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 6 !Vida! Breast Cancer Education For Survivors, Families & Caregivers and Providers Via Telemedicine</p><p> e) All of the above</p><p>6) Phantom Breast Pain is:</p><p> a) A referred pain</p><p> b) Develops weeks after the procedure</p><p> c) The same thing as Phantom Breast sensation.</p><p> d) Phantom Breast pain has a good prognosis.</p><p>Thank you very much for taking the time to complete all study forms</p><p>You may submit the completed forms in any of the following ways:</p><p>Via fax: (520) 626-2225 ATTN: Angela or</p><p>Via mail : Arizona Cancer Center ATTN: Angela Valencia 1515 N. Campbell Ave Tucson, AZ 85724 or Via e-mail to: [email protected]</p><p>If you nave any questions please call: (520) 626-3265 Bettina Hofacre</p><p>Vida! Session Packet for HCP PLEASE KEEP ALL FORMS TOGETHER 7</p>