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  1. Surveys
  2. 2016
  3. April
  4. D
  5. Depression/Anxiety in Cancer patients
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Exit Survey
 
 
Dear Participants,

This survey is being conducted as a part of the Thesis for Master’s degree, by Ms. Nisha Devi Muthu Krishnan from Eastern Michigan University. You are invited to participate in a survey on "Patient’s perception of cancer related Depression/Anxiety during their treatment”.

In this survey, cancer patients will be asked to complete a survey that asks questions about emotional issues during their cancer treatment. Survey results will be used to assess the depression/anxiety prevalence in cancer patients.

Your participation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw at any time.

It will take approximately 7-10 minutes of your time to complete the questionnaire, and your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. Your survey responses will be strictly confidential, we will not collect your name and other identifiers, and data from this research will be reported only in aggregate.

ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

• you have read the above information
• you voluntarily agree to participate
• you are at least 18 years of age

If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.
 
 
 
 
Are you a cancer patient who are currently receiving cancer treatment?
 
Yes
 
No
 
 
 
* Age
 
18-29
 
30-44
 
45-59
 
60+
 
 
 
* Gender
 
Male
 
Female
 
 
 
Which race/ethnicity best describes you?
 
American Indian or Alaskan Native
 
Asian / Pacific Islander
 
Black or African American
 
Hispanic
 
White / Caucasian
 
Other
 
 
 
 
* Please mention your type of cancer
 
Breast
 
Gastrointestinal
 
Lung
 
prostate
 
Leukemia/lymphoma
 
Bladder/kidney
 
Other
 
 
 
 
What type of treatment you are taking for your cancer?
 
Chemotherapy
 
Radiation
 
Combination therapy
 
Surgery
 
Other
 

 
 
Hospital Anxiety and Depression Score (HADS)

How you have been feeling in the past week?
Yes definitely Yes, Sometimes No, not much No, not at all
I feel tense or 'wound up'
I still enjoy the things I used to enjoy
I get a sort of frightened feeling as if something awful is about to happen
I can laugh and see the funny side of things
Worrying thoughts go through my mind
I feel cheerful
I can sit at ease and feel relaxed
I feel as if I am slowed down
I get a sort of frightened feeling like 'butterflies' in the stomach
I have lost interest in my appearance:
I feel restless as I have to be on the move
I look forward with enjoyment to things
I get sudden feelings of panic
I can enjoy a good book or radio or TV program
 
 
 
Have you ever discussed your depression/anxiety issues with your oncologists?
 
Yes
 
No
 
 
 
If your answer is YES to Q.8, attempt this:
Did you receive any treatment for your depression/anxiety?
 
Yes
 
No