Surveys
2014
August
P
Post-Transplant Patient Survey

Post-Transplant Patient Survey

Hello:
You are invited to participate in our survey of patients that have had a kidney transplant. In this survey, approximately 500 people will be asked to answer questions about being a kidney transplant patient. It will take approximately 20 minutes to complete the questionnaire.

It is very important for us to learn your opinions. However, your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

I Agree

The person I rely on most to help me with my healthcare decisions is...

UM Physician

Local Physician

UM Nurse

UM Social Worker

Spouse/Family Member/Other Helper

How IMPORTANT is your relationship with each of the following people?

	Not important at all to me	A little important to me	I'm neutral about it	Very important to me	Extremely important to me
UM Physician

Local Physician

UM Nurse

UM Social Worker

Spouse/Family Member/Other Helper

To what extent do you AGREE or DISAGREE with each of the following statements?

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I will not need to go on dialysis in the future.

I will have no organ rejection episodes in the future.

I will not be hospitalized due to kidney problems in the future.

I will not have infections related to my kidney transplant in the future.

I am able to manage my weight.

I will not develop cancer in the future.

To what extent do you AGREE or DISAGREE with each of the following statements. If not applicable to you, select "not applicable".

	Strongly Disagree	Disagree	Neither Agree Nor Disagree	Agree	Strongly Agree	N/A
I am able to manage my high blood pressure.

I am able to manage my high cholesterol (lipids).

I am able to manage my bone disease.

I am able to manage my diabetes.

Rate the IMPORTANCE of each of the following from "no importance" to "high importance".

	Not important at all to me	A little important to me	I'm neutral about it	Very important to me	Extremely important to me
Taking the smallest dosage of each medication.

Taking the smallest number of medications.

Taking the lowest cost medications.

Keeping my cost of laboratory and other medical testing as low as possible.

Minimizing the number of clinic appointments and lab testing visits.

I take the drugs my doctor has prescribed...

Never

Occasionally

About half the time

Most of the time

All of the time

To what extent do you AGREE or DISAGREE with each of the following statements?

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I will feel healthy in the future.

I will perform my normal daily activities in the future (including employment, if applicable).

My diet will not be restricted in the future.

How true are each of these statements for you?

	Not at all true	A little true	Somewhat true	Mostly true	Always true
My life has purpose and meaning.

I have a sense of balance among all aspects (work, home, recreation, etc.) of my life.

I am at ease and feel relaxed.

I look forward to upcoming events.

I can control my emotions.