Questionnaire

Conducting Interviews

UNC Health Registry aims to conduct the first interview with newly enrolled participants within 2 weeks of enrollment. Interviews may be conducted over the phone or in-person on the day of a clinic visit. The baseline general interview takes approximately 45 minutes.

To view progress in contacting participants for baseline general interviews, click here.

BASELINE QUESTIONNAIRE TOPICS

Demographics

Gender
Age
Race/ethnicity
Marital status
Education
Contact Information

Health History

Cancer screening
Reproductive history
Comorbidities
Medications
Cancer symptoms – Rotterdam*

Lifestyle

Living conditions
Tobacco use
Alcohol use
Physical activity – GPAQ
Historical height/weight
Work impact - WAI

Patient Reported Outcomes (PRO)

Quality of life
General - SF-12 & PROMIS global
General cancer-specific – FACIT
Sexual function – PROMIS
Cognitive function – FACIT
Functional status – PG-SGA

Health Care System

Access to health care
Patient provider communication - PSQ-18
Referring Physician

Cancer Specific Topics

FACIT cancer-specific modules
Additional symptoms
Relevant cancer-specific topics

Baseline General Questionnaires are administered to all participants. To view the Baseline General Questionnaire, click here.