Questionnaire to the thermo-coagulator providers

Thermo-coagulation is one of the ablative techniques used for the treatment of cervical precancerous lesions for which more scientific evidence is needed in terms of efficacy, acceptability and safety. Besides acceptability of the women treated, it is important to collect the opinion of the providers of thermo-coagulation. We would be grateful of you could fully complete the questionnaire below. Your opinion, and the opinion of other providers will be compiled and you will be informed of the findings.

Thank you!

1. Country:

2. Institute:

3. Name:

4. Date of completion:

D-M-Y

5. Position:

Specify:

6. Place of treatment

Specify

7. Perform regularly colposcopy:

8. Experienced in performing colposcopy:

9. Experienced in performing LEEP:

10. Received training on thermal ablation:

11. Model of thermal ablation used:

Specify:

12. Framework of use of thermal ablation:

Specify:

1.a Number of women treated per day:

1.b Number of women treated per month:

1.c Number of women treated per year:

2. Age range of treated women (in years) - Minimum age:

Age range of treated women (in years) - Maximum age:

3. Include women HIV positive:

4. Follow-up visit of women treated:

5. Thermal-ablation performed in which context:

Specify:

1. Ease of use of thermo-coagulator:

1.a How many treatments were performed on an average before needing to change or charge the battery (for Liger only)?

1.b Which diameter of the probe do you use most frequently?

1.c Are you satisfied with the probe length and shape:

1.d Ease of setting up time and temperature (Liger only):

2. Acceptability by the women:

3. Safety of the treatment:

4.a 1:

4.b 2:

4.c 3:

4.d 4:

4.e 5:

5.a Instrument stops working:

5.b Timer not showing time correctly:

5.c Battery problems:

5.d Probe becomes loose:

5.e Other, specify:

6. Recommendation of thermal ablation to colleagues:

7. Preference vis-à-vis cryotherapy for the same indications:

8. Preference vis-à-vis LEEP for the same indications:

9. Satisfaction about sterilization procedure:

1. Do you use local anaesthesia:

2. Duration of treatment per application (in seconds):

3. Approximate number of cases that you can treat with a fully charged battery (for Liger only):

4.a Heating the probe:

4.b For how any seconds:

4.b Soak in Cidex® or disinfectant:

4.c Other, specify:

1. Availability of cryotherapy:

2. Availability of CO2/NO2 for cryotherapy:

2.b If yes, number of cryotherapy units:

3. Availability of LEEP:

3.b If yes, number of LEEP units:

4. Availability of thermal-ablation:

4.a If yes, number of non-mobile thermal-ablation units:

4.b If yes, number of mobile thermal-ablation units:

5.a Advantages of thermo-coagulator

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5.b Disadvantages of thermo-coagulator

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