test Gravity Forms - Colorectal Cancer Canada

Welcome to the N2Y Psychoeducational Intervention, developed by Colorectal Cancer Canada to support early-age onset colorectal cancer (EAO CRC) patients and caregivers.

We recognize the unique emotional, relational, and practical challenges that can arise during this journey. This intervention is designed to help you reflect on these experiences and provide guidance through practical, self-guided exercises.

The process begins with a short questionnaire to help you identify which areas of your life may feel most impacted.

Based on your responses, you will be provided with tailored suggestions for exercises that are designed to help you build resilience and address your most pressing challenges.

Please note that this questionnaire is not a diagnostic tool and is not intended for clinical evaluation. Its purpose is to help guide you towards the most relevant resources and exercises that may support you in managing the emotional and practical challenges associated with EAO CRC. The results are for your personal reflection and use only.

This is a self-guided and flexible tool. You can choose to engage with any of the exercises that feel most helpful to you, at your own pace. Your experiences and needs are unique, and this intervention is designed to support you in the way that works best for you. Thank you for taking this step towards enhancing your well-being.

Please press next to get started.

I am a...

Early age onset colorectal cancer patient

Early age onset colorectal cancer caregiver

Professional and Academic Challenges

My health condition has negatively affected my ability to meet work or educational demands*

Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

Prefer not to answer

I worry that my health condition will impact my ability to reach my career or educational goals.*

My health condition negatively impacts my confidence in my professional or academic abilities*

I find it challenging to stay motivated in my work or studies due to my health condition*

My employer or academic institution is unsupportive of my health condition*

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

I feel uncomfortable talking to my employer or school about accommodations for my health*

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

Ce champ est masqué lorsque l‘on voit le formulaire.

Patient Number – Professional and Academic Challenges

Self-Perception and Identity Issues

My health condition negatively affects my self-confidence*

My health condition negatively affects my sense of self or personal identity*

My body image has been negatively affected by my health condition or treatment*

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

I struggle with accepting my current self-image  *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

I find myself comparing my current abilities or appearance to what they were in the past*

I feel that my physical appearance negatively influences how others perceive me*

Ce champ est masqué lorsque l‘on voit le formulaire.

Patient Number – Self-Perception and Identity Issues

Interpersonal and Intimate Relationship Challenges

My health condition has negatively affected my ability to connect emotionally with my partner or loved ones*

My health condition has negatively affected my ability to connect physically with my partner*

I feel isolated or distant from loved ones due to my health condition*

My health condition has negatively impacted my ability to pursue and maintain personal relationships*

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

I feel that my health challenges prevent me from participating in social activities*

I feel uncomfortable reaching out to my support system or those closest to me for emotional support*

Ce champ est masqué lorsque l‘on voit le formulaire.

Patient Number – Interpersonal and Intimate Relationship Challenges

Emotional and Psychological Challenges

I feel anxious, stressed, or fearful about the future*

I feel emotionally or physically exhausted*

Grief (grief of sense of self, previous capacity, previous daily life) or loss has impacted my emotional well-being*

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Prefer not to answer

I worry about aspects of my health beyond my control*

Thoughts about my health and/or my future keep me from enjoying daily activities*

I feel that my stress is unmanageable/overwhelming*

Ce champ est masqué lorsque l‘on voit le formulaire.

Patient Number – Emotional and Psychological Challenges