CAHPS® Cancer Care Radiation Therapy Survey
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  • 1. Our records show that you received care from the hospital or clinic listed below.   Label with name of facility goes here   Is that right?
  • 2. Has a doctor, nurse or other health care professional ever told you that you have cancer?
  • 3. Radiation therapy uses high-energy radiation like x-rays or radioactive implants to kill cancer cells and shrink tumors. Have you ever received radiation therapy from this cancer center?
  • 4. Is this cancer center the place you usually go to if you need a check-up, want advice about a health problem, or get sick or hurt?
  • 5. How long have you been treated at this cancer center for cancer?
  • 6. When were you first diagnosed with your cancer?
  • 7. Radiation therapy team refers to the doctors, nurses, therapists, technicians, and their support staff involved with your radiation therapy through this cancer center. Since it was decided that you would have radiation therapy, did your radiation therapy team encourage you to contact them with questions between visits?
  • 8. Since it was decided that you would have radiation therapy, did your radiation therapy team tell you to call them immediately if you have certain symptoms or side effects?
  • 9. Since it was decided that you would have radiation therapy, did your radiation therapy team give you clear instructions about how to contact them after regular office hours?
  • 10. Since it was decided that you would have radiation therapy, did your radiation therapy team involve your family members or close friends in discussions about your cancer or cancer care as much as you wanted?
  • 11. When was the last time you received radiation therapy for cancer from this cancer center?
  • 12. In the last 6 months, how many times did you visit this cancer center to get care from your radiation therapy team? Do not include telephone calls or emails.
  • 13. In the last 6 months, did you contact this cancer center to get an appointment for an illness, injury, or condition that needed care right away?
  • 14. In the last 6 months, when you contacted this cancer center to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?
  • 15. In the last 6 months, did you make any appointments for a check-up or routine care at this cancer center?
  • 16. In the last 6 months, when you made an appointment for a check-up or routine care at this cancer center, how often did you get an appointment as soon as you needed?
  • 17. In the last 6 months, did you contact this cancer center with a medical question during regular office hours?
  • 18. In the last 6 months, when you contacted this cancer center during regular office hours, how often did you get an answer to your medical question that same day?
  • 19. Radiation therapy team refers to the doctors, nurses, therapists, technicians, and their support staff involved with your radiation therapy through this cancer center. In the last 6 months, how often did your radiation therapy team explain things in a way that was easy to understand?
  • 20. In the last 6 months, how often did your radiation therapy team listen carefully to you?
  • 21. In the last 6 months, how often did your radiation therapy team seem to know the important information about your medical history?
  • 22. In the last 6 months, how often did your radiation therapy team show respect for what you had to say?
  • 23. In the last 6 months, how often did your radiation therapy team spend enough time with you?
  • 24. In the last 6 months, did your radiation therapy team order a blood test, x-ray, or other test for you? Do not include radiation therapy.
  • 25. In the last 6 months, when you had blood tests, x-rays, or other tests as part of your cancer treatment, how often did someone from this cancer center follow up to give you those results?
  • 26. In the last 6 months, did you take any prescription medicine?
  • 27. In the last 6 months, how often did you and your radiation therapy team talk about all the prescription medicines you were taking?
  • 28. In the last 6 months, did you and your radiation therapy team talk about pain related to your cancer or radiation therapy?
  • 29. In the last 6 months, were you bothered by pain from your cancer or radiation therapy?
  • 30. In the last 6 months, did your radiation therapy team advise you about or help you deal with this pain?
  • 31. In the last 6 months, did you and your radiation therapy team talk about any changes in your energy levels related to your cancer or radiation therapy?
  • 32. In the last 6 months, were you bothered by changes in your energy levels related to your cancer or radiation therapy?
  • 33. In the last 6 months, did your radiation therapy team advise you about or help you deal with these changes in your energy levels?
  • 34. In the last 6 months, did you and your radiation therapy team talk about any emotional problems, such as anxiety or depression, related to your cancer or radiation therapy?
  • 35. In the last 6 months, were you bothered by any emotional problems, such as anxiety or depression, related to your cancer or radiation therapy?
  • 36. In the last 6 months, did your radiation therapy team advise you about or help you deal with these emotional problems?
  • 37. Additional services to manage your cancer care at home include home health care, special medical equipment, or special supplies. In the last 6 months, did you and your radiation therapy team talk about these additional services?
  • 38. In the last 6 months, did you and your radiation therapy team talk about things you can do to maintain your health during cancer treatment such as what to eat and what exercises to do?
  • 39. Using any number from 0 to 10, where 0 is the worst radiation therapy team possible and 10 is the best radiation therapy team possible, what number would you use to rate your radiation therapy team?
  • 40. An interpreter is someone who helps you talk with others who do not speak your language. Interpreters can include staff from this cancer center, telephone interpreters, friends, or family members. In the last 6 months, was there any time when you needed an interpreter at this cancer center?
  • 41. In the last 6 months, when you needed an interpreter to speak with your radiation therapy team, how often did you get one?
  • 42. Considering all your cancer care at this cancer center, using any number from 0 to 10, where 0 is the worst overall cancer care experience possible and 10 is the best overall cancer care experience possible, what number would you use to rate your overall cancer care experience?
  • 43. In the last 6 months, how often were clerks and receptionists at this cancer center as helpful as you thought they should be?
  • 44. In the last 6 months, how often did clerks and receptionists at this cancer center treat you with courtesy and respect?
  • 45. Besides radiation therapy, did you receive other types of cancer treatments or services from this cancer center?
  • 46. How do you prefer to make decisions about your cancer treatment?
  • 47. In the last 6 months, did you have an overnight hospital stay for your cancer?
  • 48. In general, how would you rate your overall health?
  • 49. In general, how would you rate your overall mental or emotional health?
  • 50. What is your age?
  • 51. Are you male or female?
  • 52. What is the highest grade or level of school that you have completed?
  • 53. Are you of Hispanic or Latino origin or descent?
  • 54. What is your race? Mark one or more.
  • 55. Did someone help you complete this survey?
  • 56. How did that person help you? Mark one or more.

Supplemental Item Sets Hide Numbering

Click on items or set of items that you want to add.

    • AC3. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?
    Access to After Hours Care
    • AC1. In the last 6 months, did you contact this cancer center with a medical question after regular office hours?
    • AC2. In the last 6 months, when you contacted this cancer center after regular office hours, how often did you get an answer to your medical question as soon as you needed?
    • INF1. Since it was decided that you would have radiation therapy, did your radiation therapy team clearly explain how your cancer and radiation therapy could affect your normal daily activities?
    • INF2. In the last 6 months, did your radiation therapy team tell you what the next steps in your radiation therapy would be?
    • INF3. In the last 6 months, how often did your radiation therapy team explain those results in a way that was easy to understand?
    Cancer team prescribed medicine patient hadn't taken before
    • INF4. In the last 6 months, did your radiation therapy team prescribe medicine that you had not taken before?
    • INF5. In the last 6 months, did your radiation therapy team explain what that medicine was for in a way that was easy to understand?
    Doctor talked with patient about more than one way to treat patient's cancer
    • N-SDM1. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about more than one way to treat your cancer?
    • N-SDM2. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center clearly explain the advantages of each choice for cancer treatment, including the treatments you did not get?
    • N-SDM3. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center clearly explain the disadvantages of each choice for cancer treatment, including the treatments you did not get?
    • N-SDM4. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center ask for your opinion about each choice of cancer treatment, including the treatments you did not get?
    Doctor talked about reasons patient might want each cancer treatment choice
    • N-SDM5. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about the reasons you might want to have radiation therapy?
    • N-SDM6. Since your cancer was diagnosed, did a doctor or other health care professional at this cancer center talk with you about the reasons you might not want to have radiation therapy?
    • N-SDM7. Since your cancer was diagnosed, when you talked about having radiation therapy, did a doctor or other health care professional at this cancer center ask you what you thought was best for you?
    • N-SDM8. Since your cancer was diagnosed, did a doctor or other health professional at this cancer center involve you in decisions about your cancer treatment as much as you wanted?