Supportive Care Services Use Questionnaire

The Supportive Care Services Use Questionnaire is a 18-item instrument which evaluates respondents’
reported use of and unmet need for a) information or information resources, b) emotional support services, and
c) practical support services. It was derived from prior qualitative research and theories of stress and coping as
applied to cancer survivors. Respondents rate each service or resource on a four-point Likert scale where 1 is
“YES, and I don’t need it anymore”, 2 is “YES, and I would like to use more”, 3 is “NO, but I would like to”, and
4 is “NO, and I do not need to”. This questionnaire was originally developed for use in the adolescent and
young adult population.

Scoring instructions:

Service Use Score: To calculate a score for service use, assign each item a score of 1 if the respondent
endorsed having used that service and a score of 0 if they had not used and/or had no need of that service.

Unmet Need Score: To calculate a score for unmet need, assign each item a score of 1 if the respondent
endorsed not having used the service but would have liked to use it. Assign items a score of 0 if they already
had used the service and/or had no need for the service.

To cite this instrument, please use the following reference:

Lim JW, Zebrack B. Social networks and quality of life for long-term survivors of leukemia and
lymphoma. Support Care Cancer.2006;14:185-192.

Please note that this instrument has not been psychometrically validated and may change over time.

Supportive Care Services Use Questionnaire – Lim & Zebrack, 2006

We would like to know what kinds of services you have used since being diagnosed with cancer, and if you
would or would not like to use more of them in the future. Please circle only one number for each item.

YES. YES. NO. NO.

And I don’t And I would like But I would And I do not
Have you ever used this service?
need it to use more like to need to
anymore
1. Counseling services by a social worker,
1 2 3 4
psychologist or psychiatrist.
2. Counseling for family members. 1 2 3 4
3. Herbal treatments, acupuncture, meditation,
visualization, biofeedback or any other 1 2 3 4
complementary/alternative medicine (CAM)
4. Camps, retreats, adventure programs or social
activities that offer cancer education or 1 2 3 4
support.
5. Treatment to help me have children after
1 2 3 4
cancer (including sperm or egg banking)
6. Adoption Services 1 2 3 4
7. Counseling related to sexuality or intimacy. 1 2 3 4
8. The Internet to get cancer education or
1 2 3 4
support.
9. A support group 1 2 3 4
10. Help with understanding health insurance,
1 2 3 4
disability or social security.
11. Child care. 1 2 3 4
12. Transportation assistance (such as taxi
vouchers, bus passes, American Cancer 1 2 3 4
Society, or other medical transportation).
13. Alcohol or drug abuse counseling. 1 2 3 4
14. Religious or spiritual support. 1 2 3 4

Now we would like to know what kinds of information you have used since being diagnosed with cancer, and if
you would or would not like to use more of them in the future. Please circle only one number for each item.

YES. YES. NO. NO.

Have you received… And I don’t And I would But I would like And I do not
need anymore like more to need to
15. Information about your cancer, treatment or
1 2 3 4
possible health problems related to cancer.
16. Information about having children after cancer. 1 2 3 4
17. Information about diet and nutrition 1 2 3 4
18. Information about exercise and physical
1 2 3 4
fitness.

Supportive Care Services Use Questionnaire – Lim & Zebrack, 2006