Appendix I

Appendix 1 - Pre and post-course questionnaire
To be administered by the Course coordinator to IACA -TIPS trainees at the beginning and at the end of the course.
Please use the following Scale to fill the questionnaire.

1. Unfamiliar 2. Somewhat Unfamiliar 3. Neutral 4. Somewhat Familiar 5.Familiar
* Required
Name of the Centre *
Choose
Trivandrum Institute of Palliative Sciences, Thiruvananthapuram
MNJ Institute of Oncology, Hyderabad
Tata Memorial Hospital, Mumbai
Gujarat Cancer Research Institute, Ahmedabad
Cipla Palliative Care and Training Centre, Pune
CanSupport, New Delhi
Kasturba Medical College, Manipal, Karnataka
Date *
MM
/
DD
/
YYYY
Profession of the Trainee *
Required
Name of the Trainee *
Your answer
Feedback Type *
Were you practicing palliative care before the course? YES/NO, if yes then answer the next question
Clear selection
How many patients with palliative care needs you were seeing per week?
Your answer
To me PALLIATIVE CARE means *
Your answer
For the following items, please indicate your familiarity with each topic: PALLIATIVE CARE
1. Unfamiliar 2. Somewhat Unfamiliar 3. Neutral 4. Somewhat Familiar 5.Familiar
Principles of supportive and palliative care *
Unfamiliar
Familiar
Members of a multi-disciplinary team and their roles *
Unfamiliar
Familiar
Existing barriers and stigma facing palliative care *
Unfamiliar
Familiar
Palliative Medicine as a speciality *
Unfamiliar
Familar
Differences between the therapeutic goals of palliative care and goals of conventional medical therapy *
Unfamiliar
Familar
ASSESSMENT TOOLS
Use of a scale to evaluate pain, fatigue, nausea, depression, anxiety, dyspnea, appetite, sleep disturbances, well-being *
Unfamiliar
Familiar
Use of a scale to evaluate delirium *
Unfamiliar
Familiar
PAIN MANAGEMENT
Different types of pain - nociceptive and neuropathic *
Unfamiliar
Familiar
Multidimensional assessment of pain - physical & emotional *
Unfamiliar
Familiar
Non-opioid and opioid medications for pain *
Unfamiliar
Familiar
Oral /transdermal routes of opioid administration and their advantages *
Unfamiliar
Familiar
Principles of maintenance and breakthrough dosing of opioids *
Unfamiliar
Familiar
Indications and method for opioid rotation and switching *
Unfamiliar
Familiar
Indications and utility of radiation, chemotherapy, nerve block, or surgery for managing pain *
Unfamiliar
Familiar
FATIGUE
Common causes of fatigue in cancer and palliative care patients *
Unfamiliar
Familiar
Underlying causes and their management with pharmacotherapy *
Unfamiliar
Familiar
Use of cognitive-behavioral therapy, physical exercise, light therapy *
Unfamiliar
Familiar
Preventing sleep disturbances *
Unfamiliar
Familiar
NAUSEA
Common causes of nausea in cancer and palliative care patients *
Unfamiliar
Familiar
Assessing a patient with chronic nausea *
Unfamiliar
Familiar
Receptors involved in nausea *
Unfamiliar
Familiar
Underlying causes and their management with pharmacotherapy *
Unfamiliar
Familiar
ANOREXIA AND CACHEXIA
Mechanism of anorexia and cachexia *
Unfamiliar
Familiar
Assessing and managing a patient with anorexia or cachexia *
Unfamiliar
Familiar
Utility of artificial nutritional support (IV, NG, PEG) *
Unfamiliar
Familiar
Challenges in managing patients with ostomies and catheters *
Unfamiliar
Familiar
CONSTIPATION
Common causes of constipation in cancer and palliative patients *
Unusual presenting symptoms of constipation e.g. delirium, pain, nausea & vomiting, anorexia *
Unfamiliar
Familiar
Assessing a patient with constipation *
Unfamiliar
Familiar
Measures for prevention of constipation *
Unfamiliar
Familiar
Managing chronic constipation *
Unfamiliar
Familiar
ANXIETYand DEPRESSION
Screening for anxiety and depression *
Unfamiliar
Familiar
Multi-disciplinary team in managing psycho-social concerns of person and family *
Unfamiliar
Familiar
Treatment of anxiety/depression in cancer and palliative patients *
Unfamiliar
Familiar
Recognizing risk factors for complicated bereavement *
Unfamiliar
Familiar
DYSPNOEA
Assessment of chronic progressive dyspnoea *
Unfamiliar
Familiar
Palliative management of subjective dyspnoea *
Unfamiliar
Familiar
Role of opioids in symptomatic management of dyspnea *
Unfamiliar
Familiar
DELIRIUM
Diagnostic criteria and common risk factors *
Unfamiliar
Familiar
Common presentations of the clinical subtypes (hyperactive, hypoactive, mixed) *
Unfamiliar
Familiar
Non-pharmacological management of a patient with delirium *
Unfamiliar
Familiar
Managing a patient with delirium *
Unfamiliar
Familiar
Counseling family members of patients with delirium *
Unfamiliar
Familiar
Episodic course of delirium *
Unfamiliar
Familiar
Role of palliative sedation in managing terminal delirium *
Unfamiliar
Familiar
COMMUNICATION TECHNIQUES
Using verbal and non-verbal communication techniques at the bedside or in a family meeting *
Unfamiliar
Familiar
Skills in conveying bad news( Components of Advance Care Planning, Living will, Medical power of Attorney, Do Not Resuscitate etc.) *
Unfamiliar
Familiar
Outcomes of delivering bad news poorly, late, or not at all *
Unfamiliar
Familiar
What information is to be shared, how much and with whom -patient, family members *
Unfamiliar
Familiar
Familiarity and utility of family meetings *
Unfamiliar
Familiar
Communicating regarding transition of care needs for a patient with advanced disease with professional colleagues *
Unfamiliar
Familiar
END OF LIFE [EOL] CONSIDERATIONS
Significance of maximizing quality of life *
Unfamiliar
Familiar
Your answer
Components of Advance Care Planning (Living Will, Medical Power of Attorney, Do Not Resuscitate orders) *
Unfamiliar
Familiar
Effects of delirium on patient mental capacity *
Unfamiliar
Familiar
Addressing emotional and spiritual needs *
Unfamiliar
Familiar
Invasive interventions in the context of end of life care (e.g. investigations, nutrition & hydration, IV antibiotics, surgery / chemo-radiation therapy *
Unfamiliar
Familiar
MEDICAL ETHICS IN ADVANCED DISEASE
Principle of non-maleficence and examples in advanced disease *
Unfamiliar
Familiar
Principle of beneficence and examples in advanced disease *
Unfamiliar
Familiar
Principle of autonomy and examples in advanced disease *
Unfamiliar
Familiar
Principle of justice and examples in advanced disease *
Unfamiliar
Familiar
HOME BASED CARE
Concept of home based care *
Unfamiliar
Familiar
Organization and team requirements in home based care programs *
Unfamiliar
Familiar
Contents in home care kit *
Unfamiliar
Familiar
Care and support interventions possible through home based care
Unfamiliar
Familiar
Clear selection
Role of community in home care program *
Unfamiliar
Familiar
Role of community in home care program *
Unfamiliar
Familiar
Logistics and costing of home based care program *
Unfamiliar
Familiar
Submit
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy