|
1
|
In which of the following employment settings do you carry out the majority of your professional responsibilities as an oncology practitioner? (If you work in more than one setting, please select the ONE setting where you spend MOST of your time.)
| Academic Institution (post secondary) |
| Acute care hospital |
| Acute rehabilitation hospital |
| Hospital based outpatient facility or clinic |
| Home health care |
| Research center |
| SNF/ECF/ICF/sub-acute rehabilitation facility |
| Hospice |
| Free-standing outpatient clinic |
| Other - Please specify |
|
| |
2
|
Please indicate the percentage of your work time that is spent in this setting: ______ %
| |
3
|
If you work in more than one setting, please select the ONE setting where you spend THE SECOND MOST amount of your time.
| Not applicable |
| Academic Institution (post secondary) |
| Acute care hospital |
| Acute rehabilitation hospital |
| Health system |
| Hospital-based outpatient facility or clinic |
| Home health care |
| Research center |
| SNF/ECF/ICF/sub-acute rehabilitation facility |
| Hospice |
| Free-standing outpatient clinic |
| Other (please specify) |
|
| |
4
|
Please indicate the percentage of your work time that is spent in this setting: _____ %
| |
5
|
Is your practice associated with any of the following?
| Comprehensive cancer center |
| Community cancer center |
| Not applicable |
| |
6
|
Please rank the professional activities that you perform. (1 is most frequent)
| 1 | 2 | 3 | 4 | 5 | 6 |
| Direct oncology physical therapy patient/client management |
|
|
|
|
|
|
| Direct patient/client management other than oncology care |
|
|
|
|
|
|
| Consultation in oncology care |
|
|
|
|
|
|
| Administration/management |
|
|
|
|
|
|
| Teaching in oncology |
|
|
|
|
|
|
| Research in oncology |
|
|
|
|
|
|
| |
7
|
What ONE educational method has had the MOST influence on developing your present level of oncology clinical skills?
| Self study (books, articles, videotapes, home study courses) |
| Inservice, peer interaction care |
| Continuing education courses, workshops, seminars, study groups |
| Mentoring |
| Entry-level PT program |
| Post-Graduate program |
| Other (please specify) |
|
| |
8
|
What is the total number of years you have been a physical therapist?
| |
9
|
What is the total number of years you have practiced oncology physical therapy?
| |
10
|
What is your current employment status? (please select one)
| Full-time salaried/hourly |
| Part-time salaried/hourly |
| Full- time self employed |
| Part-time self employed |
| Volunteer/pro bono |
| |
11
|
What is the age range of the patients you routinely work with?
| Less than 21 years of age |
| 21-65 years of age |
| 65+ |
| N/A |
| |
12
|
Primary Diagnoses: How frequently do you see patients with each of the following types of cancer?
1
Never | 2
Less than once a month | 3
One to three times a month | 4
Weekly | 5
Three times a week to daily |
| Bone |
|
|
|
|
|
| Brain |
|
|
|
|
|
| Breast |
|
|
|
|
|
| Germ cell tumors |
|
|
|
|
|
| Head and Neck (e.g., pharyngeal, thyroid etc) |
|
|
|
|
|
| Hematological Cancers (e.g. leukemia, lymphoma, etc) |
|
|
|
|
|
| Lung |
|
|
|
|
|
| Melanoma |
|
|
|
|
|
| Gastrointestinal (e.g., colon, rectal, stomach, etc) |
|
|
|
|
|
| Genitourinary (e.g., cervical, prostate etc) |
|
|
|
|
|
| Sarcoma (e.g., bone, soft tissue) |
|
|
|
|
|
| Other |
|
|
|
|
|
| |
13
|
Secondary Diagnoses: how frequently do you see patients with each of the following impairments? (A patient may have more than one impairment; include the impairment when it is significant to your clinical decision making.)
1
Never | 2
Less than once a month | 3
One to three times a month | 4
Weekly | 5
Three times a week to daily |
| Amputations other than limb salvage (e.g. mastectomy, penectomy) |
|
|
|
|
|
| Balance impairments |
|
|
|
|
|
| Bone metastases and pathologic fractures |
|
|
|
|
|
| Cachexia |
|
|
|
|
|
| Cancer-related fatigue |
|
|
|
|
|
| Cancer-related pain |
|
|
|
|
|
| Cardiopulmonary impairments |
|
|
|
|
|
| Central nervous system disorders |
|
|
|
|
|
| Chemotherapy-induced peripheral neuropathy with motor impairments |
|
|
|
|
|
| Chemotherapy-induced peripheral neuropathy with sensory impairments |
|
|
|
|
|
| Cognitive impairment |
|
|
|
|
|
| Erectile dysfunction |
|
|
|
|
|
| Frailty, malnutrition, dehydration |
|
|
|
|
|
| |
16
|
What is your entry level physical therapy education?
| Certificate |
| Bachelor’s degree |
| Master’s degree |
| DPT |
| |
17
|
What is your highest earned degree beyond entry level physical therapy degree?
| Advanced Master’s in Physical Therapy |
| Other Master’s degree |
| DPT |
| Doctoral Degree (PhD/EdD/clinical doctorate, other) |
| No degrees beyond entry level |
| |
18
|
If you are ABPTS CERTIFIED, what is your specialty?
| |
19
|
Do you hold another certification? (e.g. Certified Lymphedema Therapist, Certified Wound Specialist, ATC)
If yes, please list certification(s)
| |
20
|
Which of the following best describes your racial/ethnic background?
| American Indian or Alaskan NativeAsian or Pacific Islander |
| African-American or Black (not of Hispanic origin) |
| White (not of Hispanic origin) |
| Hispanic/Latino |
| Other, please specify |
|
| |
21
|
Are you a member of APTA?
| |
22
|
Are you a member of the Oncology Section?
| |
23
|
The Oncology Section and the American Board of Physical Therapy Specialties are working together to develop this practice analysis in order to offer a board certification exam in Oncology. There is a detailed application process and the cost of the application and exam is currently $1200. The certification exam is administered through the National Board of Medical Examiners. Certification is good for ten years.
When this board certification process is available, do you plan to take the exam?
| Yes, definitely |
| Yes, but not for a few years |
| Probably not |
| No |
| |
24
|
The Oncology Section and APTA’s Department of Professional Development are working together to develop this practice analysis in order to offer facilities a blueprint for residency and/or fellowship education in Oncology physical therapy practice. Residency and fellowship programs are planned post-professional educational programs for physical therapists in a specialty area (residency) or sub-specialty area (fellowship) and include clinical mentoring and didactic education.
Would you or your facility be willing to develop a residency and/or fellowship in Oncology physical therapy?
| Yes, definitely |
| Yes, but not for a few years |
| Probably not |
| No |
| |
25
|
Would you be interesting in enrolling in a residency and/or fellowship program specific to Oncology physical therapy?
| Yes, definitely |
| Yes, but not for a few years |
| Probably not |
| No |
| |
|
|