How would you describe your role?*

Academic ( Research and/or teaching)
Medical / Medical Specialist
Nursing professional
Psychosocial Clinician ( i.e. Social worker, psychologist)
Health Services Manager
Policy (policy manager, policy officer, policy assistant)
Student (PhD, Masters, undergraduate)
Other (specify)

How would you describe your professional discipline?*

Palliative Care Researcher
Palliative Care Clinician
Psychology
Social Work
Palliative Care Nursing
Biostatistics
Epidemiology
Health Economics
Public Health
Allied Health
Other (specify)

Are you actively involved in palliative care research*
--- Yes No
If yes, how long have you been active
--- Less than 2 years 3-6 Years 7-10 Years 10 or more years

Please indicate the areas of palliative care research you are interested in:*

Population Group
Cancer Type
Types of care / interventions
Psychosocial
Symptom Management
Quality of life
Bereavement and grief
Spiritual
Malignant disease
Non-Malignant Disease
Other (specify)

Please expand upon your areas of interest

Why would you become a member of PCRNV?*

Help with grant concept development
Mentorship
Networking with other researchers
Opportunities to collaborate
Access to funds for projects
Access to funds for fellowships / scholarships
All of the above
Other (specify)

What type of PCRNV events would you most likely attend/ be interested in attending:*

Research Meetings
Research Forums
Concept Development Days
Other (specify)

What format do you prefer PCRNV to communicate with you?*

Newsletters
Brochure
Email
Invitations to PCRNV events
Website
Face to face relationship building
Updates on latest projects
Not at all
Other (specify)

What would be your preferred frequency of communication form PCRNV?*

--- Quarterly Bi-monthly Monthly Other, please specify

What do you think the key issues in palliative care research are?*

Resources and funds
Political issues and policies influencing funding and health initiatives
Collaboration opportunities
Networking opportunities
Building research capacity
Lack of awareness of palliative care
Lack of media and promoting the cause
Other (specify)