Form 1 PCP Script-Screener

Attachment 8

Primary Care Physician Script-Screener

SPARCCS – PCP Script-Screener

1. Hello, have I reached Dr. (FIRST, MIDDLE INITIAL, LAST NAME)’s office?

YES > [GO TO INTRODUCTION BELOW]

NO > I’m trying to reach the office of Dr. (NAME) on (STREET) in (CITY, STATE). Do you know (him/her)?

IF YES: Would you know how I could reach (him/her)?

IF NEEDED: Do you know (his/her) telephone number/address/ the name of a person who might know how to reach (him/her)? [FOLLOW LEADS]

IF NOT KNOWN/NO LEADS: Thanks for your time. [SEND TO TRACING]

WRONG NUMBER > Do you know Dr. (LAST NAME)?

If YES: Would you know how to reach (him/her)?

IF NEEDED: Do you know (his/her) telephone number/address/ the name of a person who might know how to reach (him/her)? [FOLLOW LEADS]

IF NOT KNOWN/NO LEADS. Thanks for your time. [SEND TO TRACING]

NO LONGER WORKS THERE > Do you have a forwarding telephone number and address for the doctor?

IF NEEDED: Do you know the name of a person who might know how to reach (him/her)? [RECORD NAME AND SEND TO TRACING]

IF NOT KNOWN/NO LEADS: Thanks for your time. [SEND TO TRACING]

DECEASED,

RETIRED,

NOT IN PRACTICE,

NOT AVAILBLE DURING FIELD PERIOD,

REFUSED > [MARK ANSWER] Thanks for your time.

INTRODUCTION

This is (INTERVIEWER NAME) I am calling on behalf of the National Institutes of Health regarding a study of physicians’ attitudes regarding the care of cancer survivors.

2. Is Dr. (LAST NAME)’s specialty (SPECIALTY)?

YES > [MARK ANSWER CONTINUE TO 3].

NO or NOT VOLUNTEERED: What is (his/her) specialty?

• IF THE SPECIALTY IS ONE OF THE INCLUDED SPECIALTIES

> [MARK ANSWER CONTINUE TO 3].

• IF THE SPECIALTY IS NOT ONE OF THE INCLUDED SPECIALTIES, [WRITE DOWN SPECIALTY, THEN]:

> Those are all the questions I have, thank you for your help.

DON’T KNOW > CONTINUE TO 4

REFUSED > Thanks for your time

3. I’d like to confirm that I have the correct address for Dr. (LAST NAME).

I have (his/her) office at (ADDRESS, CITY, STATE, and ZIP).

ADDRESS CORRECT > [CONTINUE]

ADDRESS UPDATES > [SPELL OUT ALL NEW INFORMATION AND CONTINUE]

DON’T KNOW > [ASK TO SPEAK TO SOMEONE TO CONFIRM ADDRESS AND CONTINUE]

REFUSED > Thank you for your time. [HANG UP AND CALL BACK LATER].

4. Does Dr. (LAST NAME) see all of his/her patients in one of the following settings?

• A hospital? [CHECK YES OR NO]

• A Federal Facility, such as the U. S. Public Health Service, Veterans Administration or Indian Health Service? [CHECK YES OR NO]

• A nursing home or rehabilitation center? [CHECK YES OR NO]

• A correctional facility? [CHECK YES OR NO]

YES,

NO,

DON’T KNOW,

REFUSED > [MARK ANSWER AND CONTINUE]

5. Does Dr. (LAST NAME) see patients anywhere else other than the location just described?

YES

NO > Thank you very much for your time.

[MARK ANSWER AND HANG UP]

INTERVIEWER COMMENTS: [ALL COMMENTS WILL BE REVIEWED BY A SUPERVISOR AND THE OFFICE WILL BE RECONTACTED IF CLARIFICATION IS NEEDED.]