Impact of Blood Transfusion on Quality of Life (QoL) "*" indicates required fields Step 1 of 4 25% Project description If you are receiving frequent blood transfusions due to your disease or taking care of someone who receives frequent blood transfusions, this survey is for you. . By participating, you share your experience and contribute to improving patient care. Heal Canada is a not-for-profit patient organization working to understand the reality of patients who need frequent blood transfusion by conducting this 15-minute survey. We have designed the survey to ensure your privacy and confidentiality. Your anonymized responses are used only by Heal Canada for this project. We sincerely appreciate your participation. Thank you!1. For which disease category do you receive blood transfusion?* Blood Cancer (leukemia, lymphoma, MPN, etc) Solid Cancer (Breast, Rectal, Lung, etc) Non-Cancer blood disorder (ITP, Thalassemia, etc) Other (please specify) 1. For which disease category do you receive blood transfusion? (Other)*2. Please select all the reasons mentioned for receiving transfusions.* Fatigue Anemia Hemoglobin too low Disease progression Other (please specify) 2. Please select all the reasons mentioned for receiving transfusions. (Other)*3. Please select the option that best describes how often you receive transfusion.* At least once a week Once a month Every two months Every three months Infrequent, as needed 4. In general, how many units of blood do you receive?* one two three Four or more 5. How long have you been receiving transfusions?* Less than a year 1 – 2 years 2-5 years More than five years 6. Please select the option that best describes how long it takes to drive to receive a blood transfusion.* One hour or less Around two hours Around three hours Around four hours More than four hours 7. Please select the option that best describes how long it takes to receive a transfusion from admission to discharge.* Around two hours Around four hours Around six hours Around eight hours More than eight hours 8. How often have you been hospitalized due to an adverse reaction?9. Please select all adverse reactions you have experienced during a transfusion.* Fever Fatigue Infections Allergic reaction Anaphylactic reaction Blood pressure drop (Hypotensive reaction) Obstruction or blockage in a blood vessel (Embolism) Destruction of red blood cells that can lead to hemolytic anemia (Hemolysis) Immune reaction to foreign human protein (Alloimmunization) Other (please specify) 9. Please select all adverse reactions you have experienced during a transfusion. (Other)*10. Please select all symptoms experienced because of your transfusion.* Fatigue Pain, body aches or severe pain Sleep issues (deprived or abnormal sleep) Restless leg syndrome Reduced daily living and functional capabilities Impacted cognitive functioning Emotional and mental health issues (anxiety, depression) Other (please specify) 10. Please select all symptoms experienced because of your transfusion. (Other)*11. Do your benefits from the transfusion wear off before the next one?* Yes No 12. Do you need someone with you when you receive a transfusion? No Yes Iron Overload13. Did your physician talk to you about iron overload?* Yes No 14. Do you receive any medication to reduce the iron level in your blood?* Yes No I am not sure Daily living impact of blood transfusion15. What is your level of stress regarding your transfusion? From 0 (not stressful at all) to 100 (very stressful)*16. Is receiving transfusions impacting your quality of life? From 0 (no impact at all) to 100 (significant impact)*17. Please select all challenges experienced due to your transfusions. No particular challenge Budget struggles Work challenges Having a good quality of life daily Work-Life Balance Family responsibilities Daily house related tasks Emotional and/or mental health Healthcare Access Other (please specify) 17. Please select all challenges experienced due to your transfusions. (Other)*18. What is your age?19. In which city and country did you live in?* Impact of blood transfusion in working status20. Please select the option that best describes your current employment status.*Employed, working full-timeEmployed, working part-timeNot employed, looking for workNot employed, not looking for workRetiredDisabled, not able to work.21. Have your transfusions impacted your working status?* No Yes (please specify) 21. Have your transfusions impacted your working status? (Specify)*22. Please select the option that best describes your principal caregiver's current employment status.*Employed, working full-timeEmployed, working part-timeNot employed, looking for workNot employed, not looking for workRetiredDisabled, not able to work.23. Have your transfusions impacted your principal caregiver's working status?* No Yes (please specify) 23. Have your transfusions impacted your principal caregiver's working status? (Specify)*EmailThis field is for validation purposes and should be left unchanged. Δ
