CTWG survey with AG

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ATTACHMENT 17
Baseline and Follow-Up Survey to Determine Awareness Levels and Communications Preferences of Advocates Regarding Colorectal Cancer Clnical Trials
______________________________________________________________________________

OMB #0925-0046-18a
Exp. Date: 10/31/2006

National Cancer Institute 
Clinical Trials Awareness Survey with Advocacy Group Members/ Constituents

The National Cancer Institute (NCI) is working with the Colon Cancer Alliance (CCA) and C3: Colorectal Cancer Coalition to raise awareness about colorectal cancer clinical trials.  As part of this effort, we are conducting this survey with advocacy group members and constituents to determine their current level of clinical trials knowledge and awareness. We will be conducting a follow-up survey in approximately one year to see if awareness levels have changed.  To this end, please provide us with your e-mail address below so that we may send you this brief follow-up survey. 

This survey should take approximately 5 minutes to complete, and your participation in this survey is completely voluntary.  Your responses will be kept confidential and will not be disclosed to anyone outside NCI or its contractor, NOVA Research Company, except as otherwise required by law.  Data will be provided to the NCI in aggregate form only, with any potentially identifying information removed.  You may skip any questions that you prefer not to answer.
 
Thank you for taking the time to complete this survey. 

    1. What is your e-mail address?

    2. With respect to your involvement with C3 or CCA, how would you primarily describe yourself?
        a. Cancer patient, please specify:
            i. Recently diagnosed and have not decided on treatment
            ii. In treatment
            iii. Completed treatment within the last year
        b. Cancer survivor (1 year or more since treatment ended)
        c. Caregiver/family member/friend of a cancer patient
        d. Medical professional (please specify: _________________)
        e. Other (please specify: _____________________________ ) 

    3. How familiar are you with clinical trials?
        a. Very familiar
        b. Somewhat familiar
        c. Not at all familiar

    4. If you are very or somewhat familiar with clinical trials, what is your main source of information about clinical trials?  (Check all that apply)
        a. Medical professionals
        b. Media
            i. TV
            ii. Radio
            iii. Newspaper
            iv. Magazine
            v. Internet
        c. Materials from CCA or C3
        d. Materials from the National Cancer Institute 
        e. Materials from other cancer organizations (please specify: __________________)
        f. Other (please specify: ____________________) 

    5. Have you heard of any of these NCI colorectal cancer clinical trials? (Select all that apply) 
        a. Cetuximab and/or Bevacizumab Combined With Combination Chemotherapy in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer (Study # C80405)
        b. Bevacizumab and Oxaliplatin Combined With Irinotecan or Leucovorin and Fluorouracil in Treating Patients With Metastatic or Recurrent Colorectal Cancer (Study # E4203)
        c. Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer (Study # E5202)
        d. Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II or Stage III Rectal Cancer (Study # E5204)
        e. Radiation Therapy and Either Capecitabine or Fluorouracil With or Without Oxaliplatin Before Surgery in Treating Patients With Resectable Rectal Cancer (Study # NSABP-R-04)

    6. For any of these trials that you have heard of, how did you hear about them?
        a. National Cancer Institute, select all that apply:
            i. Web site (www.cancer.gov)
            ii. 1-800-4-CANCER
            iii. Other NCI resources
        b. CCA or C3, select all that apply:
            i. Web site
            ii. E-newsletter
            iii. Listserv announcement
            iv. Toll-free number
            v. Meeting/special event
            vi. Patient education materials
            vii. Other (please specify: _________________________)
        c. Other cancer organization (Specify organization:_________________________), select all that apply:
            i. Web site
            ii. E-newsletter
            iii. Listserv announcement
            iv. Toll-free number
            v. Meeting/special event
            vi. Patient education materials
            vii. Other (please specify: __________________________)
        d. Don’t recall
        e. Other (please specify: _________________________________)

    7. After first hearing about these trials, what actions, if any, did you take to get more information about the trials?  (Check all that apply)
        a. Went to www.cancer.gov (e.g., PDQ, Clinical Trials Web page)
        b. Called 1-800-4-CANCER
        c. Called CCA Helpline
        d. Called C3 Clinical Trials Matching line
        e. Spoke to a health professional about one of these trials
        f. Contacted a study coordinator at one of the trial sites
        g. Other (please specify: ________________________________)
        h. None

Demographic information 

Please enter the following demographic information:
    1. Gender: 
            a. Male
            b. Female
    2. Age:
            a. Under 21
            b. 21-30
            c. 31 – 40
            d. 41 – 50
            e. 51 – 60
            f. 61 -  70
            g. 71 -  80
            h. over 80
    3. Zip code:
    4. Ethnicity: 
            a. Hispanic or Latino 
            b. Not Hispanic or Latino
    5. Race: 
            a. American Indian or Alaska Native 
            b. Asian 
            c. Black or African American 
            d. Native Hawaiian or Other Pacific Islander
            e. White

Visit http://www.cancer.gov/clinicaltrials/developments/NCD179N if you would like more information on the trials listed in this survey. Thank you for your time.  We may be following-up with you via e-mail in approximately one year.  If you have any questions about this survey, please contact Dan Eckstein at 301-986-1891 or [email protected].
OMB #0925-0046-18b
Exp. Date: 10/31/2006


National Cancer Institute 
Follow-up Clinical Trials Awareness Survey with Advocacy Group Members/ Constituents

For the past year, the National Cancer Institute (NCI) has worked with the Colon Cancer Alliance (CCA) and C3: Colorectal Cancer Coalition to raise awareness about colorectal cancer clinical trials.  As part of this effort, we are conducting this survey with advocacy group members and constituents to see if our promotional efforts to increase awareness have made an impact. 

Your participation in this survey is completely voluntary. Please be assured that your responses will be kept confidential and will not be disclosed to anyone outside NCI or its contractor, NOVA Research Company, except as otherwise required by law. Data will be provided to the NCI in aggregate form only, with any potentially identifying information removed. You may skip any questions that you prefer not to answer. This survey should take approximately 4 minutes to complete.

Thank you for taking the time to complete this survey. 

    1. With respect to your involvement with C3 or CCA, how would you primarily describe yourself?
        a. Cancer patient, please specify:
            i. Recently diagnosed and have not decided on treatment
            ii. In treatment
            iii. Completed treatment within the last year
        b. Cancer survivor (1 year or more since treatment ended)
        c. Caregiver/family member/friend of a cancer patient
        d. Medical professional (please specify: _________________)
        e. Other (please specify: _____________________________) 

    2. How familiar are you with clinical trials?
    a. Very familiar
    b. Somewhat familiar
    c. Not at all familiar

    3. Have you heard of any of these NCI Colorectal Cancer clinical trials? (Select all that apply) 
        a. Cetuximab and/or Bevacizumab Combined With Combination Chemotherapy in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer (Study # C80405)
        b. Bevacizumab and Oxaliplatin Combined With Irinotecan or Leucovorin and Fluorouracil in Treating Patients With Metastatic or Recurrent Colorectal Cancer (Study # E4203)
        c. Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer (Study # E5202)
        d. Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II or Stage III Rectal Cancer (Study # E5204)
        e. Radiation Therapy and Either Capecitabine or Fluorouracil With or Without Oxaliplatin Before Surgery in Treating Patients With Resectable Rectal Cancer (Study # NSABP-R-04)

    4. For any of these trials that you have heard of, how did you hear about them?
    a. C3 promotions, select all that apply:
            i. C3 Web site
            ii. Momentum newsletter
            iii. Listserv announcement
            iv. Clinical Trials Matching Service
            v. C3 toll-free number
            vi. Meeting/special event
            vii. Patient education materials
            viii. Clinical trials e-newsletter
            ix. Clinical trials teleconference
            x. Other C3 activity (please specify: _________________________)
    b. CCA promotions, select all that apply:
            i. CCA Web site
            ii. The Voice newsletter
            iii. Listserv announcement
            iv. Patient Support Helpline
            v. Buddy Program
            vi. Meeting/special event
            vii. Other CCA activity (please specify: _________________________)
    c. National Cancer Institute, select all that apply:
            i. Web site (www.cancer.gov) 
            ii. 1-800-4-CANCER
            iii. Other NCI resources
    d. Media, select all that apply:
            i. TV
            ii. Radio
            iii. Newspaper
            iv. Magazine
            v. Internet
    e. Medical professionals
    f. Materials from other cancer organizations
    g. Other (please specify: _________________________)

    5. After hearing about these trials, what actions, if any, did you take to get more information about the trials?
        a. Went to www.cancer.gov (e.g., PDQ, Clinical Trials Web page)
        b. Called 1-800-4-CANCER
        c. Called CCA Helpline
        d. Called C3 Clinical Trials Matching line
        e. Spoke to a health professional about one of these trials
        f. Contacted a study coordinator at one of the trial sites
        g. Other (please specify: ________________________________)
        h. None


Demographic information 

Please enter the following demographic information:
    6. Age:
            a. Under 21
            b. 21-30
            c. 31 – 40
            d. 41 – 50
            e. 51 – 60
            f. 61 -  70
            g. 71 -  80
            h. over 80
    7. Zip code:

Visit http://www.cancer.gov/clinicaltrials/developments/NCD179N if you would like more information on the trials listed in this survey. Thank you for your time. If you have any questions about this survey, please contact Dan Eckstein at 301-986-1891 or [email protected].