Decision Aid - Questionnaire

Decision aid

Questionnaire

1. What country do you live in?

2. How old are you?

3. What mutation do you have?

4. Have you had breast cancer?

	Yes
	No

5. Did you undergo a preventive mastectomy?

	Yes
	No

6. How did you find this decision aid? (multiple answers possible)

	Through my doctor / nurse
	Through my loved ones
	Through the information sheet
	Through the TUBA-WISP II website
	I found it myself on the internet
	Through Facebook
	Other:

7. Did you already know what surgery you prefer, before using the decision aid?

	No, I am not sure (yet)
	Yes, Removal of fallopian tubes and ovaries at the same time
	Yes, Remove fallopian tubes first and remove ovaries later
	Yes, No surgery (at this moment)

8. Why do you want to use the decision aid? (multiple answers possible)

	Because I want to get more information about BRCA and the risk of cancer
	Because I want to get more information about preventive options and their pros and cons
	Because I would like to get more insight into the things that are important for me in making a choice
	Because I have doubts about my choice
	Because I want to check whether I have understood everything correctly
	Other:

9. May we contact you later to ask what you thought of the decision aid?

	I would prefer not to be contacted
	Yes, my e-mail address is: