Breconda - Breconda

Breast Cancer Network Australia

Breconda Registration Form

Name

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Username

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E-mail

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Password

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We are interested in who is using BRECONDA. Please indicate your primary reason for visiting the BRECONDA site

Please make a selection

Your primary reason for visiting the BRECONDA site

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Please indicate your age group

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Place of Residence

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Place of Residence (Other)

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We are interested in the timing of reconstruction you are considering. Is it for an immediate or delayed breast reconstruction?

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Have you already received any information about breast reconstruction?

YesNo

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At this point in time, how satisfied are you with information you have received about breast reconstruction?

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Thinking about the decision whether or not to go ahead with breast reconstruction, please indicate how you are feeling about this decision

Do you feel sure about the best choice for you?

YesNo

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Do you know the benefits and risks of each option?

YesNo

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Are you clear about which benefits and risks matter most to you?

YesNo

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Do you have enough support and advice to make a choice?

YesNo

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How did you find BRECONDA?

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How you found BRECONDA

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Which of the following best describes your profession?

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Your profession

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What is your age?

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Please indicate which of the following approaches you currently take to assist your patients to reconstruction

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The decision aid

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The approach you currently take to assist your patients to reconstruction:

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How did you find BRECONDA?

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How you found BRECONDA

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Would it be OK if we contacted you about participating in future research related to BRECONDA?

YesNo

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I agree to the terms and conditions

Please agree to the terms and conditions

Download Terms & Conditions PDF

Lead developer: Kerry Sherman, PhD
Funded by: Cancer Australia and National Breast Cancer Foundation
Last updated: October 2019 (Updated Biennially)