Pink & Pearl Survey

We are exploring the feasibility of creating a Pink and Pearls Campaign to cross-promote lung cancer screening among those participating in breast cancer screening. We invite you to take a few minutes to complete our survey and share your thoughts. Your input is invaluable as we continue this work.

1. How many routine screening mammograms do your perform, on average?

Monthly

Annually

2. How would you rate your staffing level?

At capacityAbove capacityBelow capacity

3. Which of the following staff do patients encounter during their mammography appointment? (Select all that apply)

Secretary or medical assistant (check In)Radiology techNurse navigatorBreast imaging physicianOther staff members not listed

Other:

4. Do you talk with your patients about other preventative screenings during routine screening mammograms?

YesNo

Which screenings?

Who shares this information?

At what point during the visit?

Why don't you discuss other screenings?

Would you consider discussing other screenings?

YesNo

Which part of the visit would it make the most sense to provide this education?

Before, waiting roomAfter imagingWhen sharing mammogram resultsOther

Other:

5. Please rank the following methods in order of their effectiveness for providing additional screening information to patients (1 = Least Effective, 3 = Most Effective).

Verbally

Mammography results letter

Posters or brochures in changing or waiting rooms

Can you suggest any other methods of delivery?

6. In which type of facility is your department?

AcademicCommunity HospitalFree Standing Radiology

7. Of the patients you see for breast cancer screening, about what percentage do you think may also be eligible for lung cancer screening (age 50+, current or past tobacco exposure)?

Very fewUp to 10%Between 10% and 20%More than 20%Not sure

Optional

Would you be willing to provide your contact information for follow-up from LUNGevity?

YesNo

Name

Organization