Attachment C2_Focus group of providers and staff at each intervention and control practice

Pre-Intervention Practice Focus Group Guide

&

Control Practice Focus Group Guide

INTRO:	Hello. My name is ______________ and I am the moderator for today’s 30 minute group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss colorectal cancer screening in your practice.
Moderator Info:	The Lehigh Valley Physician Hospital Organization along with the Thomas Jefferson University and The CNA Corporation will be conducting a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with physicians, other clinicians, clinical staff, and office staff who were part of our study (or part of our comparison group). Your input is important to help us understand how to implement an intervention designed to increase colorectal cancer screening and tracking.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after obtaining signatures] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.

GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Before we begin, does everyone know each other? [If not, do self intros with first names only]

QUESTIONS:

Theme 1: Understanding Current Guidelines

1. What guidelines for colorectal cancer screening do you follow?

2. What guidelines for colorectal cancer screening follow up do you use?

3. How do you keep up to date with changes to the guidelines?

4. Are you familiar with the recent update of the guidelines?

   1. If so, can you describe the new guidelines?

5. How do you manage conflicting or confusing statements between the guidelines?

Theme 2: Patient Awareness

6. How aware do your patients seem to be regarding colorectal cancer screening?

1. What does this vary with (e.g. age, gender, culture)?

7. Do you think your patients are aware of the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

8. How do your patients get information about colorectal cancer screening?

Theme 3: Screening Activities

9. To whom do you recommend colorectal cancer screening?

10. To whom do you recommend colorectal cancer screening follow up?

11. How much time do you spend making the recommendations?

12. Do you offer the patient a range of acceptable screening choices?

13. What percentage of patients agree to be screened?

14. If your patients have an initial positive colorectal cancer screen, what percentage of patients agree to receive appropriate colorectal cancer screening follow-up?

15. What are the barriers that prevent you from making a recommendation?

16. What are the barriers to patient acceptance?

17. What are the facilitators to patient acceptance?

18. Do you think this practice’s current colorectal cancer screening process has an economic impact on the practice?

    1. Describe to me how you think it economically impacts the practice.

       1. What do you think are some positive impacts?

       2. What do you think are some negative impacts?

19. Do you think this practice’s current colorectal cancer screening process has an impact on the practice’s reputation?

    1. Describe to me how you think it impacts the practice’s reputation.

       1. What do you think are some positive impacts?

       2. What do you think are some negative impacts?

Theme 4: Process Improvement

20. What would help improve the way in which colorectal cancer screening is made available to your patients?

21. How could tracking of patient screening be improved?

22. How could tracking of CRC follow up be improved?

Post-Intervention Practice Focus Group Guide

INTRO:	Hello. My name is ______________ and I am the moderator for today’s 30 minute group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss colorectal cancer screening in your practice.
Moderator Info:	The Lehigh Valley Physician Hospital Organization along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with physicians, other clinicians, clinical staff, and office staff who were part of our study. Your input is important to help us understand how to implement an intervention designed to increase colorectal cancer screening and tracking.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after obtaining signatures] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.
GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Before we begin, does everyone know each other? [If not, do self intros with first names only]

QUESTIONS:

Theme 1: Satisfaction with Intervention

1. Describe to me your overall level of satisfaction with this colorectal cancer screening intervention?

   1. What do you think worked well?

   2. What do you think didn’t work well?

Theme 2: Educational Benefit to the Practice

2. Has this intervention changed your understanding about colorectal cancer screening guidelines?

3. Has this intervention changed your understanding about appropriate colorectal cancer screening follow up procedures?

4. Did you change which patients received a colorectal cancer screening recommendation?

   1. Did you change which patients received a CDE recommendation?

5. Did your rate of recommendation change for colorectal cancer screening or CDE? Explain.

Theme 3: Perceived Impact on Patients

6. We sent your eligible patients information on colorectal cancer screening and an invitation to be screened ...

1. How did this appear to influence their awareness?

2. How did this appear to influence their behavior?

3. Do you think the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines played a role in their decision to get screened or not get screened?

7. How did your practice perceive the patient response to the screening invitation?

8. Who did it impact in the practice? How?

9. Did the intervention change the nature or content of your discussions with patients about screening? How?

Theme 4: Process Improvement and Maintenance

10. Describe to me what it was like to adopt and implement this intervention in your practice.

    1. What were the interventions’ strengths?

    2. What were the interventions’ weaknesses?

11. Based on your experience with this program, if we wanted to introduce this screening intervention into other practices ...

    1. What would you suggest we do differently and why?

    2. What would you suggest we do the same and why?

    3. What would you suggest to improve the way this screening process impacts ...

       1. The practice?

       2. Patients?

12. Do you, or does this practice, intend to adopt this screening process and continue it in the future? Explain why or why not.

    1. What would be required for you and your practice to continue this in the future?

13. Would you encourage other organizations to adopt this process?

Theme 5: Effectiveness

14. Tell me what types of benefits this intervention could bring to the practice?

15. How do you think this intervention impacted this practice economically?

    1. Describe to me the positive economic benefits.

    2. Describe to me any negative economic consequences.

16. How do you think this intervention impacted this practice’s reputation?

    1. Describe to me the positive benefits.

    2. Describe to me any negative consequences.