2021 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.

The primary CLL-specific Support Group I attend is:

If you attend more than one Support Group, please select the other Support Groups below:

Atlanta Metro CLL Support Group

Boston CLL Support Group

Central Florida CLL Support Group

Central Massachusetts CLL Support Group

Chicago CLL Support Group

Cincinnati CLL Patient Support Group

City of Hope CLL Support Group

Denver CLL Support Group

DFW – Dallas Area CLL Patient Support Group

Fort Lauderdale CLL Support Group

Houston-area CLL Support Group

Long Island CLL Support Group

Milwaukee CLL Support Group

Montreal CLL Support Group

Nashville CLL Support Group

New Jersey CLL Patient Support Group

New Orleans and Surrounding Areas CLL Support Group

New York City CLL Support Group

Northeast Ohio CLL Support Group

Oberlin, OH, CLL Patient Support Group

Orange County CLL Support Group

Orlando CLL Support Group

Philadelphia CLL Patient Support Group

Portland CLL Support Group

Raleigh Area CLL Patient Support Group

Rochester NY CLL Support Group

Rockland County NY CLL Support Group

Sacramento CLL Patient Support Group

Salt Lake City CLL Support Group

San Diego CLL Society Support and Education Meeting

San Francisco area CLL Patient Support Group

Seattle and All Points North CLL Support Group

Seattle-Olympic Peninsula CLL Support Group

Suncoast CLL Support Group (Sarasota)

Toronto CLL Support Group

Twin Cities CLL Support Group

Washington DC-area CLL Support Group

West LA CLL Support Group

Western North Carolina CLL Patient Support Group

Physicians with CLL Support Group

Please answer all questions, whether or not you are the patient.

Concerning Living with CLL/SLL:

	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 Primary Local CLL Society Support Group:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I would recommend my primary 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 primary local CLL Society Support Group.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

CLL Society is considering launching one or two CLL-focused support groups that are organized around a shared characteristic, interest, or treatment in addition to the support groups organized by geographic location in 2022.

I would be interested in the following CLL-focused support group meeting; please select all that apply:

Caregivers

Living Alone or Without a Caregiver

Younger Patients & Caregivers (55 years old or younger)

Watch and Wait (active observation)

Aggressive CLL / Richter’s Transformation

Clinical Trials / Experimental Treatments

I am not interested in any of these options

Other, please specify:

What webinar topics would you be interested in CLL Society hosting?

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?

Male

Female

Non-binary / third gender

Transgender

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

Which of the following best describes the area you live in?

Urban

Suburban

Rural

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

Support Group meetings will continue to take place virtually as the threat of the COVID-19 pandemic remains. Please let us know how we could improve virtual support group meetings or any other comments or feedback you would like to provide. All survey responses are confidential, unless you would like to include your name with your response.

Confidential comments or feedback:

Full Name and Email Address (Optional):

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