2020 Patient & Caregiver Support Group Member Survey

Questions marked with a * are required

Please take a few moments to let us know about your experience with the CLL Society Patient & Caregiver Support Group. Your feedback will allow us to demonstrate the value and impact of these groups, and call attention to ways in which we can improve the experience for you and other members of the CLL community. Thank you in advance for your time.

Which best describes your role with CLL? Please select all that apply:

CLL patient

Caregiver to a CLL patient

Loved one of CLL patient (but not the primary caregiver)

Healthcare professional

Prefer not to say

Other, please specify:

What is your age?

What is your gender?

Female

Male

Prefer not to say

Prefer to identify as:

Please specify your race and ethnicity; select all that apply:

White or Caucasian

Hispanic or Latino

Black or African American

Asian or Asian American

Indigenous, First Nation, American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Don’t know / Not sure

Prefer not to say

What is your current caregiver status?

I am or have a live-in caregiver

I am or have a caregiver that lives nearby

I am or have a caregiver that lives far away (requires plane ride or long drive)

I don't have a caregiver

Don’t know/Not sure

Prefer not to say

What is your or the CLL patient’s status of treatment for CLL?

I have not had treatment (also referred to as treatment naïve or watch and wait)

I am currently being treated for the first time or I have completed my first treatment

I have had two or more treatments or am currently being treated for the second time

Don’t know/Not sure

Prefer not to say

The primary CLL-specific Support Group I attend is:

Concerning Living with CLL:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I am more comfortable with my or the patient’s CLL diagnosis since attending my local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I feel more supported by a new network of friends whose lives also have been touched by CLL since attending my local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

Concerning CLL knowledge and management:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I am more knowledgeable about CLL since attending my local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am more involved in my or the patient’s CLL management since attending my local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I have changed the management of my or the patient’s CLL since attending my local CLL Society Support Group (i.e. different testing, treatments, or treatment teams).	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

Concerning the local CLL Society Support Group:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I would recommend my local CLL Society Support Group to other CLL patients and families.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am pleased with the leadership and facilitation of my local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

Other Types of CLL-Focused Meetings

I would be interested in attending a CLL-focused support group that is organized around a shared characteristic, interest, or treatment in addition to or instead of by geographic location. This could be based on age, treatment status, caregiver-focused, etc.

Yes

Unsure