ID
10083
Descrizione
CALGB: ADHERENCE QUESTIONNAIRE FORM (FOLLOW-UP) Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CC350-FC34-364B-E034-080020C9C0E0
collegamento
Keywords
versioni (2)
- 18/12/14 18/12/14 - Martin Dugas
- 24/03/15 24/03/15 - Martin Dugas
Caricato su
24 marzo 2015
DOI
Per favore, per richiedere un accesso.
Licenza
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Descrizione
Compliance behavior
Alias
- UMLS CUI-1
- C1321605
Descrizione
ThebenefitsofmycancertreatmentoutweighthedifficultiesIhaveinfollowingit.
Tipo di dati
text
Descrizione
IbelievethattakingmycancermedicationistoomuchtroubleforwhatIwillgetoutofit.
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text
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Becausetheschedulefortakingmycancermedicationistoodifficult,itisnotbeworthfollowingit.
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text
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Takingmycancermedicationisbetterformethannottakingit.
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text
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Takingmycancermedicationishelpingmetobehealthy.
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text
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IwillbejustashealthyevenifIwerenottakingmycancermedication
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text
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Ibelievethatmycancertreatmentishelpingtocuremeofcancer
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text
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Itishardtobelievethatmycancertreatmentishelpingme
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text
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Lotsofthingsaregettinginthewayoffollowingtheschedulefortakingmycancermedication
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text
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Ineedmoreassistanceinordertofollowtheschedulefortakingmycancermedication.
Tipo di dati
text
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IamgettingthehelpIneedtofollowmycancermedicationschedule.
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text
Descrizione
Iamabletodealwithanyproblemsintakingmycancermedication.
Tipo di dati
text
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Thesideeffectsofmycancermedicationdisruptmynormalactivities.
Tipo di dati
text
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)