すべてのテンプレート
Healthcare & Clinical

Oncology Patient Experience & Care Coordination Survey

Measures oncology patient perceptions of care access, appointment scheduling, provider coordination, and navigation support services. Designed for healthcare systems seeking to identify actionable gaps across the oncology care journey.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全26問・約11分
Q01
メッセージ

Welcome to the Oncology Patient Experience Survey. This survey asks about your recent experiences with oncology care, including scheduling, care coordination, and support services. Your responses will help us identify areas for improvement. • Participation is voluntary and you may stop at any time. • There are no right or wrong answers — we want your honest opinions. • All responses are confidential and will be reported only in aggregate. • Estimated time: 7–10 minutes. By continuing, you indicate that you have read and understood this information and consent to participate.

Q02
プルダウン

When was your most recent oncology appointment?

  • Within the last 30 days
  • 31–90 days ago
  • 3–6 months ago
  • 6–12 months ago
  • More than 12 months ago
  • I have not had an oncology appointment
Q03
オピニオンスケール

Overall, how easy has it been to access the oncology care you needed in the last 3 months?

スケール: 1 – 7
最小:Extremely difficult最大:Extremely easy
Q04
オピニオンスケール

In the last 3 months, my care providers communicated well with each other about my treatment.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q05
選択式

In the last 6 months, which navigation or support services did you use? Select all that apply.

  • Nurse navigator
  • Care coordinator
  • Social worker
  • Financial counselor
  • Transportation assistance
  • Language interpreter
  • Education classes or materials
  • Other (please specify)
  • I did not use any of these services
Q06
自由回答(長文)

Based on your experiences described in this survey, what could we improve to make navigating and coordinating your oncology care easier?

Q07
プルダウン

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75 or older
  • Prefer not to say
Q08
メッセージ

Thank you for completing this survey. Your feedback is invaluable and will be used to improve oncology care access, scheduling, and coordination for patients like you.

Q09
選択式

In the last 6 months, which types of oncology care did you use? Select all that apply.

  • Medical oncologist
  • Radiation oncologist
  • Surgical oncologist
  • Infusion/chemotherapy center
  • Imaging/radiology
  • Survivorship/after-treatment clinic
  • Palliative care
  • Other (please specify)
  • None of the above
Q10
選択式

How did you schedule your most recent oncology appointment?

  • Phone call to clinic
  • Patient portal/online
  • In person at the clinic
  • Referral arranged by another office
  • Someone else scheduled for me
  • Other (please specify)
Q11
オピニオンスケール

In the last 3 months, I felt well-informed about what to expect at each stage of my care.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q12
オピニオンスケール

Overall, how helpful were the navigation or support services you used?

スケール: 1 – 7
最小:Not at all helpful最大:Extremely helpful
Q13
AIインタビュー

We'd like to learn more about your oncology care experience. An AI moderator will ask you a couple of follow-up questions based on your responses.

Q14
選択式

Which best describes your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q15
オピニオンスケール

For your most recent appointment, how easy was it to get a convenient date and time?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q16
オピニオンスケール

In the last 3 months, transitions between different providers or departments went smoothly.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q17
オピニオンスケール

In the last 3 months, how clear was the information you received about your treatment options?

スケール: 1 – 7
最小:Very unclear最大:Very clear
Q18
プルダウン

What is your country of residence?

  • United States
  • Canada
  • United Kingdom
  • Australia
  • Germany
  • France
  • India
  • Other (please specify)
  • Prefer not to say
Q19
プルダウン

Approximately how long did you wait between scheduling and attending your most recent oncology appointment?

  • Same day
  • 1–3 days
  • 4–7 days
  • 8–14 days
  • 15–30 days
  • 31–60 days
  • More than 60 days
  • I don't remember
Q20
選択式

Is there one person who helps coordinate your oncology care across providers?

  • Yes
  • No
  • Not sure
Q21
選択式

In the last 3 months, which ways did your care team communicate with you between visits? Select all that apply.

  • Phone calls
  • Patient portal messages
  • Email
  • Text/SMS
  • Video visit/telehealth
  • Printed letters
  • Other (please specify)
  • No contact between visits
Q22
プルダウン

What is the highest level of education you have completed?

  • Less than high school
  • High school diploma or equivalent
  • Some college or 2-year degree
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q23
選択式

In the last 3 months, which of the following made it difficult to arrange your oncology care? Select all that apply.

  • Finding available appointment times
  • Getting insurance approval or authorizations
  • Travel, transportation, or parking
  • Cost or co-pays
  • Work or caregiving conflicts
  • Not knowing whom to contact
  • Other (please specify)
  • I did not experience any barriers
Q24
選択式

After your most recent visit, did you receive a written or electronic care plan with next steps?

  • Yes
  • No
  • Not sure
Q25
選択式

What is your current employment status?

  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and looking for work
  • Student
  • Retired
  • Homemaker/caregiver
  • Not currently working due to health or other reasons
  • Prefer not to say
Q26
選択式

Which racial or ethnic groups do you identify with? Select all that apply.

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino/a/x
  • Middle Eastern or North African
  • Native Hawaiian or Pacific Islander
  • White
  • Another group
  • Prefer not to say

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Purpose-built for oncology care journeys, covering access, scheduling wait times, provider coordination, and navigation/support service use rather than generic healthcare intake
  • Combines structured opinion-scale and multiple-choice questions with an open-text improvement question and a full AI follow-up interview to probe the 'why' behind low scores in real time
  • Captures care-coordination specifics competitors don't ask about, such as whether a single point-person coordinates care and whether patients received a written/electronic care plan after their visit
  • Every response is automatically quality-scored and compiled into a report, with transparent prompts showing exactly what the AI moderator asked and why

SurveySparrow

Free Patient Registration Form Template

This is a patient intake/registration form, not a patient-experience or care-coordination survey, so it addresses a different stage of the patient journey than our template. It's fielding-ready for collecting demographic and administrative intake data. Useful for onboarding, but it doesn't measure appointment access, provider coordination, or navigation support satisfaction.

優れている点

  • Likely quick to deploy for standard patient intake data collection
  • Mobile-friendly form format typical of SurveySparrow's template library

物足りない点

  • Not designed to measure care experience, access, or coordination — different use case than an oncology experience survey
  • Static form fields with no adaptive follow-up probing on patient-reported gaps
  • No automated per-response quality scoring or AI-generated qualitative insight

Jotform

Patient Care Plan Template

This is a clinical care-plan documentation form for recording a patient's treatment plan, not a survey instrument for measuring patient-reported experience or coordination satisfaction. It's fielding-ready as a documentation tool but isn't structured to benchmark access, scheduling, or navigation support across a patient population. No oncology-specific content is present.

優れている点

  • Drag-and-drop form builder typical of Jotform, easy to customize fields
  • Can output structured care-plan records for clinical documentation

物足りない点

  • Built for documenting a care plan, not surveying patients about their experience of coordination or access
  • No adaptive AI interviewing or voice AI to explore patient sentiment
  • No mechanism for automated quality scoring or synthesized reporting across many respondents

よくあるご質問

「Oncology Patient Experience & Care Coordination Survey」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が26問含まれており、最初の設問は次のとおりです:「Welcome to the Oncology Patient Experience Survey. This survey asks about your recent experiences with oncology care, i…」・「When was your most recent oncology appointment?」・「Overall, how easy has it been to access the oncology care you needed in the last 3 months?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、26問を約11分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

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