The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

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Required format:

Quality of life Program for Pancreatic Cancer Patients

Hello! Thank you for your interest in the Quality of Life Program for Pancreatic Cancer Patients.

The purpose of this study is to learn about the experiences of patients during and after treatment for pancreatic cancer. Based on these experiences, we will develop a program to promote quality of life and help relieve the stress of patients undergoing similar treatment.

Participants would take part of an interview or a focus group to help us evaluate the program.

We would like to ask you some questions to determine whether you are potentially eligible for the study. This may take approximately 1-2 minutes to complete.

If you are potentially eligible, a research assistant will call you to explain the study further and confirm your eligibility.

Date

M-D-Y

Choose a language
Escoja un idioma

English/Inglés

Spanish/Español

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1. Are you over the age of 18?

2. Are you able to speak and read the English Language?

3. Have you been diagnosed with pancreatic cancer?

4. Have you completed chemotherapy or any other cancer treatment?

5. Have you completed surgery?

6. In the past 6 months, have you been hospitalized in a mental health facility or other psychiatric facility?

Yes

Unknown

5. Completion primary treatment in the past 18-months (Y/N)

reset

6. Have no prior history of other cancer except non-melanoma skin cancer (Y/N)

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Thank you for completing this survey. A member of the study team will reach out to you.

Please provide your contact information below:

Name:
Phone Number:
May we leave a message:
Email:
Best days and times to reach you (check all that apply)?
Best days and times to reach you (check all that apply)?

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.