What does this questionnaire do?
The Accurx Rectal Bleeding Questionnaire allows the sending of an online questionnaire to patients to collect information regarding their rectal bleeding symptoms to facilitate their ongoing management.
The questionnaire link is sent via SMS or email. The patient fills in the questionnaire through a browser so can use their phone, tablet, laptop or desktop to complete it.
The responses are returned to the user or organisation via the Accurx Web inbox. The responses can be assigned to other colleagues.
What does it look like for the clinician and patient?
Clinician view of sending a Questionnaire👇
They can edit the SMS message if required
Patient perspective of viewing and completing the questionnaire👇
Questions:
1. How long ago did you start bleeding from your bottom?
(For example, for weeks ago)
Enter text
2. How often are you bleeding from your bottom?
(For example, it happens once a week or it happens everyday)
Enter text
3. How would you describe the bleeding
(Select all that apply)
Bright red blood on the toilet paper when wiping
Red streaks on the outside of my poo
Pink or red water in the toilet bowl
Blood mixed in my poo
Very dark or black poo
Other
If selected → Please describe the bleeding from your bottom in more detail
Enter text
4. Have you noticed any change to your usual bowel habit that has lasted at least six weeks?
(This means the consistency, ease of and how often you are passing stool (poo).
Select all that apply
My bowel habit has not changed
I am going to the toilet more often
I am going to the toilet less often
I have had diarrhoea (looser poo)
I have had constipation (harder poo)
Other
If selected → Please describe your bowel habit in more detail
5. Do you have any of the following symptoms alongside the bleeding from your bottom?
(Select all that apply)
Pain in my abdomen (tummy)
Pain in my bottom when having a poo
Itchiness in or around my bottom
Lumps around my bottom
Discharge from or around my bottom
None of the above
6. Have you ever been diagnosed with any of the following?
(Select all that apply)
Colorectal (bowel) cancer
Colorectal (bowel) polyp
Inflammatory bowel disease (e.g. Crohn’s disease or ulcerative colitis)
None of the above
Not sure
7. Do you have a family history of colorectal (bowel) cancer?
This means:
One or more first-degree relatives (brother, sister, parent or child) has had bowel cancer before the age of 50 or
Two or more first-degree relatives have had bowel cancer at any age)
Yes
No
I’m not sure
8. Have you had any unintentional weight loss recently?
(Unintentional weight loss is when you lose weight without changing your diet or exercise routine)
Yes
No
I’m not sure
9. Have you had a colonoscopy or flexible sigmoidoscopy in the past 12 months?
(These are camera tests used to look inside the lower part of your bowel (colon) to find a cause for symptoms such as bleeding)
Yes
No
I’m not sure
10. Usually, bleeding from your bottom is investigated with a camera test called a flexible sigmoidoscopy. If possible, would you like to be referred directly for this investigation, or would you like to have an appointment with a consultant to discuss this investigation first?
(A flexible sigmoidoscopy is a camera test used to look inside the lower part of your bowel (colon) to find a cause for your bleeding.
While we do our best to follow your preferences, this may not always be possible.)
I would like an appointment first
I would like to be referred for a test directly
I do not have a preference
When they have submitted their answers, they will be thanked for completing the questionnaire, sent a confirmation SMS and be given some safety netting information 👇
Clinician view of the Rectal Bleeding Questionnaire response
The screenshot below shows the inbox view showing a colitis activity questionnaire response for a patient 👇
Users can assign the response to a different team by clicking on the assign section 👇
Users can download a PDF version of the questionnaire response, which they can use to save responses to their paper or electronic medical records. 👇
If you still have any questions or concerns, feel free to chat with us using the green message bubble in the bottom right-hand corner of this page. 👉