Colorectal cancer screening sample member survey

These questions ask you about talking with your health care providers about colon cancer screening.

All questions in the survey are voluntary. You can skip any item.

Thank you in advance for your response, which will help us improve cancer screening for all our members!

1. Have you ever been tested for colon cancer?

2. When was your most recent colon cancer test performed? Please give an approximate answer if you don’t remember the exact date.

2. What type of colon cancer test did you receive most recently?

2. In the past ten years, did any of your health care providers talk about colon cancer testing as an option for you?

3. In the past ten years, how much did you and your health care providers talk about the reasons to you might want to be tested for colon cancer?

3. In the past ten years, how much did you and your health care providers talk about the reasons you might not want to be tested for colon cancer?

4. In the past ten years, did your healthcare providers discuss the following cancer testing options with you?

Space Cell	Yes	No
Stool blood test (example: FIT test)	Stool blood test (example: FIT test) : Yes	Stool blood test (example: FIT test) : No
Stool DNA test (example: Cologuard)	Stool DNA test (example: Cologuard) : Yes	Stool DNA test (example: Cologuard) : No
Colonoscopy	Colonoscopy: Yes	Colonoscopy: No
Another colon cancer screening test	Another colon cancer screening test : Yes	Another colon cancer screening test : No

5. In the past ten years, did any of your health care providers ask if you wanted to be tested for colon cancer?

6. In the past ten years, did any of your health care providers ask which type of colon cancer test you wanted?

7. What type of test did you want to do?

Stool blood test (example: FIT test)
Stool DNA test (example: Cologuard)
Colonoscopy
Another colon cancer screening test
I did not want to be tested

Here are some questions for you about your experiences with colorectal cancer screening. All questions are voluntary.

8. Before you go, we have a few final questions to help us interpret your answers.

Space Cell	Yes	No
Have you ever been diagnosed with colon cancer?	Have you ever been diagnosed with colon cancer? : Yes	Have you ever been diagnosed with colon cancer? : No
Have you ever had a polyp removed from your colon?	Have you ever had a polyp removed from your colon? : Yes	Have you ever had a polyp removed from your colon? : No
Do you have any close relatives (such as parents or siblings) who have had colon cancer?	Do you have any close relatives (such as parents or siblings) who have had colon cancer? : Yes	Do you have any close relatives (such as parents or siblings) who have had colon cancer? : No
Do you have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)?	Do you have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)? : Yes	Do you have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)? : No
Have your health care providers told you that you have a higher-than-average risk of developing colon cancer?	Have your health care providers told you that you have a higher-than-average risk of developing colon cancer? : Yes	Have your health care providers told you that you have a higher-than-average risk of developing colon cancer? : No