Cancer Crusaders Club
Questionnaire for Relatives of Cancer Patients
Name _____________________________________________________________Age ___ Sex ___
Pls.check under which classification your relative wants to be in and specify the type of cancer he/she had before.
Type of Cancer
|___ Cancer patient|
|___ Ex-cancer patient|
|___ Others ___________________________|
1. How many times have you attended the Annual Get-Together of the Cancer Crusaders Club? _____ (1x to 9x)
2. The following activities are usually done during the Annual Get-Together of the Cancer Crusaders Club. Pls. select two activities which you LIKE most and which you DISLIKE most and pls. give your reasons.
|Sharing of experience of your relative with other patients in public (on the stage)|
|Sharing of experience of your relative with other patients in private (on the seat)|
|Entertainment (songs and dances)|
|Raffle and gift-giving|
|Most durable award|
3. Pls. consider each statement below that describes the effect of the Annual Get-Together of the Cancer Crusaders Club and check if it is APPLICABLE to your relative. For the checked statements, determine whether they have positive (BENEFICIAL) or negative (HARMFUL) effect on your relative.
|1a. It makes my relative feel stronger in living through life with a cancer.|
|1b. It makes my relative feel weak in coping with my cancer.|
|2a. It boosts the morale of my relative.|
|2b. It lowers the morale of my relative.|
|3a. It boosts my relative’s hope for living.|
|3b. It depresses my relative’s hope for living.|
|4a. It changes my relative’s outlook in life for the better.|
|4b. It changes my relative’s outlook in life for the worst.|
|5a. It makes my relative feel like an ex-cancer patient already.|
|5b. It reminds my relative feel that he/she is a cancer patient.|
|6. It helps my relative ACCEPTS his/her cancer|
|7. It makes my relative realize that he/she is NOT the only person on earth with a cancer.|
|8a. It gives my relative an opportunity to share experience with other cancer patients in public (on stage).|
|8b. It gives my relative- an opportunity to share experience with other caner patients in private (on the seat).|
|8c. It gives my relative an opportunity to listen to the experiences of other cancer patients.|
|9a. It makes my relative learn more about cancer in general.|
|9b. It makes my relative learn more about the cancer that he/she had.|
|9c. It makes my relative learn more about patients with cancer.|
|10a. My relative and I feel the get-together is a reunion for cancer patients.|
|10b. My relative looks forward to attending the get-together each year.|
|10c. My relative looks forward to getting the most durable award.|
|11. It is a form of therapy for my relative.|
|12. It provides psychosocial support to me and my relative.|
4. For those who had attended the Annual Get-Together more than once – What made you attend AGAIN? You may have more than one answer.
___ I had to accompany my cancer relative who wanted to ATTEND AGAIN.
___ The Annual Get-Together is BENEFICIAL to my cancer relative.
___ The Annual Get-Together is helpful to me as a guardian in the care of my cancer relative.
___ The Annual Get-Together is helpful to me as a person even though I don’t have a cancer. It helps me learn more about cancer and cancer patients.
___ Others: ____________________________________________________
5. For those who had attended the Annual Get-Together only once – Why did you not ATTEND AGAIN? You may have more than one answer.
___ No invitation/no reminder
___ Problems in travel (distance and expense)
___ Conflict in schedule
___ My cancer relative does not want to attend again.
___ The Annual Get-Together has a harmful effect on my cancer relative.
___ Others: _____________________________________________________
6. Comments and suggestions for improvement of the Annual Get-Together of the Cancer Crusaders Club: