WFH | Shared Decision Making

Welcome

Introduction

Reflection

Education

Summary

STATEMENTS FOR REFLECTION

Reflect on your life with hemophilia. Your answers will not be stored. Your answers will be included in your personalized summary at the end of the tool for you to print and bring to your healthcare team.

On a scale of 0 to 100, rate how much you agree with the following statements:

1

I feel tied to (or constrained by) my hemophilia treatment regimen.

0 (Not at all) 100 (Very much)

2

Managing my hemophilia takes a lot of effort.

0 (Not at all) 100 (Very much)

3

My hemophilia is always in the back of my mind.

0 (Not at all) 100 (Very much)

4

I feel adequately protected against bleeds.

0 (Not at all) 100 (Very much)

5

I am concerned about the potential side effects of novel therapies for hemophilia.

0 (Not at all) 100 (Very much)

6

I feel upset about missing significant opportunities because of my hemophilia.

0 (Not at all) 100 (Very much)

7

My hemophilia makes it difficult to keep up a satisfying social life.

0 (Not at all) 100 (Very much)

8

My hemophilia keeps me from being able to fulfill the roles I expect to be able to do.

0 (Not at all) 100 (Very much)

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