Questionnaire, Part 2
| CONFIDENTIAL |
| Name and Designation...................................................... |
| Hospital.................................................................. |
| PLEASE TICK WHICH OF YOUR TEAM MEMBERS (INCLUDING YOURSELF) has a MAJORROLE in providing information to women with breast cancer in each of the following areas.(You may tick more than one box for each area). |
| Surgeon | Oncologist | Breast care nurse | Radiologist | Radiographer | Research nurse | Clinic nurse | Ward nurse | Chemo nurse | Other (please state) .................................................... | |
|---|---|---|---|---|---|---|---|---|---|---|
| Diagnostic tests | ||||||||||
| Test results/diagnosis | ||||||||||
| Surgery | ||||||||||
| Prostheses | ||||||||||
| Breast reconstruction | ||||||||||
| Radiotherapy | ||||||||||
| Chemotherapy | ||||||||||
| Hormone therapy | ||||||||||
| Prognosis | ||||||||||
| Staging investigations | ||||||||||
| Clinical trials | ||||||||||
| Family history | ||||||||||
| Information leaflets |