CancerEVOLVE Organizational Discovery Questionnaire
Thank you for taking a few minutes to complete this brief questionnaire. Its purpose is to help us make the most of our upcoming conversation by providing background on your organization, your initiative, and what you hope to accomplish. This questionnaire should take approximately 8 to 10 minutes to complete.
About Your Organization
Organization Name
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Department or Program
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Your Name
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Role/Title
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Others who will be participating in the meeting
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About Your Initiative
Please briefly describe the initiative or project you are developing
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What prompted your organization to begin this initiative?
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What unmet need are you hoping to address?
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What stage best describes your project?
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Exploring the idea
Planning
Developing resources
Pilot implementation
Established program
Evaluation and quality improvement
Expansion or scaling
Current Practice
How are conversations about intimacy, sexuality, relationships, and body image currently addressed within your organization?
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Which professionals are currently involved in providing this support (mark all that apply)?
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Oncology nursing
Medical oncology
Radiation oncology
Social work
Psychology/Psycho-oncology
Pelvic floor therapy
Physiotherapy
Occupational therapy
Palliative care
Survivorship program
Support group facilitators
Primary care
Other (please specify)
What educational resources are currently available for patients or partners?
How are patients referred for additional support when intimacy-related concerns arise?
Opportunities & Challenges
What do you see as your organization’s greatest strengths related to intimacy-informed survivorship care?
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What are the biggest barriers or challenges you currently face?
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Which areas would you most like to strengthen over the next 12 to 24 months?
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Success
If this initiative is highly successful one year from now, what would be different for patients?
What would be different for clinicians or staff?
How do you hope to evaluate the success of your initiative?
Looking Ahead
Are there specific topics or questions you would especially like to discuss during our meeting?
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Is there anything else you would like me to know before we meet?
Submit
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