Revised and Marked Patient Intervention Materials
Cover Letter from Physician [Flesch-Kincaid Reading Level 8.0]
MCO Letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
Our
goal at [ABQ Health Partners or Henry Ford Health System] is
to provide the best health care possible. To help us meet this goal,
we are sending you some information about colon cancer. We are
sending you this information because you have scheduled you have
scheduled a health maintenance exam an office visit with
your doctor.
The information describes colon cancer and the different medical tests that are used to check for early signs of colon cancer. Colon cancer is the third most common cancer in the United States. It is the second leading cause of cancer death in the United States. Your chances of getting colon cancer in your lifetime are about 1 in 17. The good news is that you can get tested early and colorectal cancer can often be prevented.
The colon cancer information we are sending includes:
A Fact Sheet that describes colon cancer and the different tests for colon cancer;
Frequently
Asked Questions
about the different tests for colon cancer;
A
Checklist
for completing one of the colon cancer tests, and
A
Reminder Card to
help you remember any questions or issues you would like to talk
to me about to
talk about with your doctor.
Please
read this information carefully. When you come
in go
to your appointment,
we can talk about
this
you can discuss it with your physician
and see what’s right for you. Even if you have had a colon
cancer test before, please read this information. It might be time
for you to have another colon cancer test.
Sincerely,
Revised and Marked Baseline Patient Survey-First Mailing (HFHS)
MCO LetterheadHFHS
letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
As
a Henry Ford patient and a member of Health Alliance Plan, you are
being asked to fill out a survey to find out what people think about
colon cancer screening. Your
doctor works in a clinic that is in this research study. The Centers
for Disease Control and Prevention are funding this study.Your
responses
opinions are very important to us. This survey will take
about 30 minutes
20 minutes to complete. We have enclosed $10 as
reimbursement for your time and effort.
Henry
Ford Hospital and Medical Centers works to give patients the best
health care possible and you taking part in this study will help us
do this. We are
doing this survey to help the CDC find out what people think about
colon cancer tests. The information from this survey will help the
CDC and [MCO] to find out why people get tested, and to improve
materials about colon cancer testing for doctors to use with
patients. The Centers for Disease Control and
Prevention, Battelle Center for Public Health Research, and Henry
Ford are working together on this study to find out how people feel
about colon cancer screening and your experiences talking with your
doctor about it. To participate, all you need to do is complete the
enclosed survey. Your responses will be private and will be
combined with answers from other people. Please do not put your
name on the survey. We will not identify any person who was in the
study in any papers or reports. None of your responses will be shown
to your doctor.
Your
participation in this research study is voluntary. Some
questions ask about colon cancer tests you might have had. We would
also like to know how you feel about talking to your doctor about
these things.Your returning this survey lets us know
that you have agreed to participate. You are free to choose to
complete this survey or not. You may be uncomfortable answering some
of the questions. You may refuse to answer any of the questions. If
you do not want to complete the survey, it will not change the care
you get at Henry Ford or your coverage through HAP. ].
The information from this survey will help the CDC to find out why
people do or do not have colon cancer tests
You may be contacted by mail one more time in the future so that we can learn more about the opinions and experiences you’ve had talking with your doctor about colon cancer screening. However, taking part in this survey does not mean that you have to take part in future surveys.
Please
send your completed survey to Battelle.Please use the
stamped and addressed envelope provided to return your survey.
If you have any questions about this research study, please call
[Battelle contact]
at Battelle, at (206) 528-xxxx or [MCO contact] at [MCO], at (xxx)
xxx-xxxx
Deirdre Shires at (313) 874-6248. If you have
questions about your rights as a research subject, you may Battelle’s
human subjects supervisor, Margaret Pennybacker, PhD, at
1-877-810-9530, extension 500
contact the Henry Ford Health System IRB Coordinator at
(313) 916-2024. The IRB is a group of people who review the research
to protect your rights. If you do not want to be contacted again
about this survey, please sign your name below and return this page
to us within two weeks.
We
hope you will help us with this important study. Thank you for
filling out this survey.
Sincerely,
Research Scientist
Center for Health Services Research
Research
Leader
Battelle Centers for
Public Health
Research and
Evaluation
_______________________________________does not want to take part in this survey.
Signature
Revised and Marked Baseline Patient Survey-First Mailing (ABP HP/Lovelace)
MCO Letterhead ABQ HP letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
As
an ABQ Health Partners patient and a member of Lovelace Health Plan,
you are being asked to fill out a survey to find out what people
think about colon cancer screening. Your
doctor works in a clinic that is in this research study. The Centers
for Disease Control and Prevention are funding this study.
s.
Your responses
opinions are very important to us. This survey will take about 30
minutes 20 minutes to complete. We have
enclosed $10 as
reimbursement
$10 as a token of our appreciation for
your time and effort.
ABQ
Health Partners and Lovelace Health Plan work to give patients the
best health care possible and you taking part in this study will help
us do this. We are
doing this survey to help the CDC find out what people think about
colon cancer tests. The information from this survey will help the
CDC and [MCO] to find out why people get tested, and to improve
materials about colon cancer testing for doctors to use with patient
The Centers for Disease Control and Prevention, Battelle
Center for Public Health Research, and Lovelace Clinic Foundation, a
local research organization, are working together on this study to
find out how people feel about colon cancer screening and your
experiences talking with your doctor about it. The
information from this survey will help the CDC to find out why people
do or do not have colon cancer tests.
To participate, all you need to do is complete the
enclosed survey. Your responses will be private and will be
combined with answers from other people. Please do not put your
name on the survey. We will not identify any person who was in the
study in any papers or reports. None of your responses will be shown
to your doctor.
Your
participation in this research study is voluntary. Some
questions ask about colon cancer tests you might have had. We would
also like to know how you feel about talking to your doctor about
these things.
Your returning this survey lets us know that you have agreed
to participate. You are free to choose to complete this survey or
not. You may be uncomfortable answering some of the questions. You
may refuse to answer any of the questions. If you do not want to
complete the survey, it will not change the care you get at ABQ
Health Partners or your coverage through Lovelace Health Plan.
You may be contacted by mail one more time in the future so that we can learn more about the opinions and experiences you’ve had talking with your doctor about colon cancer screening. However, taking part in this survey does not mean that you have to take part in future surveys.
Please
send your completed survey to Battelle. If you have any questions
about this research study, please call [Battelle contact] at
Battelle, at (206) 528-xxxx or [MCO contact] at [MCO], at (xxx)
xxx-xxxx. If you have questions about your rights as a research
subject, you may call Battelle’s human subjects supervisor,
Margaret Pennybacker, PhD, at 1-877-810-9530, extension 500. Please
use the stamped and addressed envelope provided to return both
your survey and the signed HIPPA form. For questions about your
rights as a research participant, you may call Independent Review
Consulting, the Lovelace Clinic Foundation’s Institutional
Review Board (IRB), at (800-472-3241) during weekday hours Pacific
Standard Daylight Time. The IRB is a group of people who review
research. They help make certain that the rights and welfare of the
study participants are protected. They also make certain that the
study is carried out in an ethical manner. If you have any
questions about this research study, please call April
Salisbury at (505) 938-9925.
We
hope you will help us with this important study. Thank you for
filling out this survey.
Sincerely,
Research
Leader
Battelle Centers for
Public Health
Research and
Evaluation
Revised and Marked Baseline Patient Survey-Second Mailing (HFHS)
MCO Letterhead HFHS Letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
Last
month we asked you to fill out a survey about colon cancer screening.
We also sent you $10 as reimbursement for your time and effort.
Our records show that you have not yet completed the survey.
If you have already filled out the survey and sent it to us,
thank you. If you have not filled out the survey and you would
still like to, please do so now. This survey will take about
20 minutes to complete. We are very interested in your opinions.
We also sent a
reminder postcard to you.
The
Centers for Disease Control and Prevention, Battelle Center for
Public Health Research, and Henry Ford are working together on this
study to find out how people feel about colon cancer screening and
your experiences talking with your doctor about it.
We are doing this survey to help the CDC find out what people think
about colon cancer tests. The information from this survey will help
the CDC and [MCO] to find out why people get tested, and to improve
materials about colon cancer testing for doctors to use with patients
To participate, all you need to do is complete the enclosed
survey. Your responses will be private and will be combined with
answers from other people. Please do not put your name on the survey.
We will not identify any person who was in the study in any papers or
reports. None of your responses will be shown to your doctor.
Your
participation in this research study is voluntary. Some
questions ask about colon cancer tests you might have had. We would
also like to know how you feel about talking to your doctor about
these things. Your returning this survey lets us know
that you have agreed to participate. You are free to choose to
complete this survey or not. You may be uncomfortable answering some
of the questions. You may refuse to answer any of the questions. If
you do not want to complete the survey, it will not change the care
you get at Henry Ford or your coverage through HAP. The
information from this survey will help CDC to find out why people do
or do not have colon cancer tests.
You may be contacted by mail one more time in the future so that we can learn more about the opinions and experiences you’ve had talking with your doctor about colon cancer screening. However, taking part in this survey does not mean that you have to take part in future surveys.
We
have included another copy of the survey in case you need it. Please
use the stamped and addressed envelope provided to return your
survey. If you have any questions about this research study,
please [Battelle
contact] at Battelle, at (206) 528-xxxx or [MCO contact] at [MCO], at
(xxx) xxx-xxxx
call Deirdre Shires at (313) 874-6248. If
you have questions about your rights as a research subject,
Battelle’s human
subjects supervisor, Margaret Pennybacker, PhD, at 1-877-810-9530,
extension 500 you may contact the Henry Ford
Health System IRB Coordinator at (313) 916-2024. The IRB is a group
of people who review the research to protect your rights. If you do
not want to be contacted again about this survey, please sign your
name below and return this page to us within two weeks.
We
hope you will help us with this important study. Thank you for
filling out this survey.
Sincerely,
Research Scientist
Center for Health Services Research
Research
Leader
Battelle Centers for
Public Health
Research
and Evaluation
_____________________________________does not want to take part in this survey.
Signature
Revised and Marked Baseline Patient Survey-Second Mailing (ABQ HP/Lovelace)
MCO Letterhead ABQ HP Letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
Last
month we asked you to fill out a survey about colon cancer screening.
We also sent you $10 as a token of our appreciation for your time
and effort. Our records show that you have not yet completed
the survey. If you have already filled out the survey and sent it
to us, thank you. If you have not filled out the survey and
you would still like to, please do so now. This survey will
take about 20 minutes to complete. We are very interested in your
opinions. We also
sent a reminder postcard to you.
We
are doing this survey to help the CDC find out what people think
about colon cancer tests. The information from this survey will help
the CDC and [MCO] to find out why people get tested, and to improve
materials about colon cancer testing for doctors to use with
patients.The
Centers for Disease Control and Prevention, Battelle Center for
Public Health Research, and Lovelace Clinic Foundation, a local
research organization, are working together on this study to find out
how people feel about colon cancer screening and your experiences
talking with your doctor about it. To participate, all you need to do
is complete the enclosed survey. Your responses will be private
and will be combined with answers from other people. Please do not
put your name on the survey. We will not identify any person who was
in the study in any papers or reports. None of your responses will be
shown to your doctor.
Your
participation in this research study is voluntary. Some
questions ask about colon cancer tests you might have had. We would
also like to know how you feel about talking to your doctor about
these things.Your
returning this survey lets us know that you have agreed to
participate. You are free to choose to complete this survey or not.
You may be uncomfortable answering some of the questions. You may
refuse to answer any of the questions. If you do not want to complete
the survey, it will not change the care you get at ABQ Health
Partners or your coverage through Lovelace Health Plan. The
information from this survey will help CDC to find out why people do
or do not have colon cancer tests.
You may be contacted by mail one more time in the future so that we can learn more about the opinions and experiences you’ve had talking with your doctor about colon cancer screening. However, taking part in this survey does not mean that you have to take part in future surveys.
We
have included another copy of the survey in case you need it. Please
use the stamped and addressed envelope provided to return both your
survey and the signed HIPPA form. If
you have any questions about this research study, please call
[Battelle contact] at Battelle, at (206) 528-xxxx or [MCO contact] at
[MCO], at (xxx) xxx-xxxx. If you have questions about your rights as
a research subject, you may call, Battelle’s human subjects
supervisor, Margaret Pennybacker, PhD, at 1-877-810-9530, extension
500.
For questions about your rights as a research participant, you may call Independent Review Consulting, the Lovelace Clinic Foundation’s Institutional Review Board (IRB), at (800-472-3241) during weekday hours Pacific Standard Daylight Time. The IRB is a group of people who review research. They help make certain that the rights and welfare of the study participants are protected. They also make certain that the study is carried out in an ethical manner. If you have any questions about this research study, please call April Salisbury at (505) 938-9925.
We
hope you will help us with this important study. Thank you for
filling out this survey.
Sincerely,
Sincerely,
Research
Leader
Battelle Centers for
Public Health
Research and
Evaluation
Revised Baseline Patient Survey-Third Mailing (HFHS)
MCO Letterhead HFHS Letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
Recently
we asked you to fill out a survey for
a research study being conducted by the Centers for Disease Control
and Prevention (CDC), [MCO], and Battelle Centers for Public Health
Research to find out more about colon cancer testing
screening. We also sent you $10 as reimbursement for your time
and important
responses and effort. You were sent two
letters and a reminder postcard about the survey. Our records show
that you have not sent
in your completed survey yet completed the survey.
If you have already filled out it
out and sent it in the survey and sent it to us,
thank you. If you have
decided to participate but have been too busy to fill out the survey,
could you please do so now?
If you have not filled out the survey and you would still like to, please do so now. This survey will take about 20 minutes to complete. We are very interested in your opinions.
The
Centers for Disease Control and Prevention, Battelle Center for
Public Health Research, and Henry Ford are working together on this
study to find out how people feel about colon cancer screening and
your experiences talking with your doctor about it. We
are doing this survey to help the CDC find out what people think
about colon cancer tests. By filling out this survey you will help us
find out why people get tested, and help the CDC to improve materials
about colon cancer testing for doctors to use with patients.
To participate, all you need to do is complete the enclosed
survey. Your responses will be private and will be combined with
answers from other people. Please do not put your name on the survey.
We will not identify any person who was in the study in any papers or
reports. None of your responses will be shown to your doctor.
Your
participation in this research study is voluntary. Some
questions ask about colon cancer tests you might have had. We would
also like to know how you feel about talking to your doctor about
these things.
Your returning this survey lets us know that you have agreed
to participate. You are free to choose to complete this survey or
not. You may be uncomfortable answering some of the questions. You
may refuse to answer any of the questions. If you do not want to
complete the survey, it will not change the care you get at Henry
Ford or your coverage through HAP.
You may be contacted by mail one more time in the future so that we can learn more about the opinions and experiences you’ve had talking with your doctor about colon cancer screening. However, taking part in this survey does not mean that you have to take part in future surveys.
We
have included another copy of the survey in case you need it. Please
use the stamped and addressed envelope provided to return your
survey. If you have any questions about this research study,
please call [Battelle
contact] at Battelle, at (206) 528-xxxx or [MCO contact] at [MCO], at
(xxx) xxx-xxxx
Deirdre Shires at (313) 874-6248. If you have
questions about your rights as a research subject, you may Battelle’s
human subjects supervisor, Margaret Pennybacker, PhD, at
1-877-810-9530, extension 500 contact the Henry
Ford Health System IRB Coordinator at (313) 916-2024. The IRB is a
group of people who review the research to protect your rights.
We
hope you will help us with this important study. Thank you for taking
this survey.
Sincerely,
Research Scientist
Center for Health Services Research
Research
Leader
Battelle
Centers for Public Health
Research
and Evaluation
| File Type | application/msword |
| File Title | Patient Intervention Materials-Cover Letter from Physician |
| Author | Dvv1 |
| Last Modified By | Judith Lee Smith |
| File Modified | 2009-03-24 |
| File Created | 2009-03-24 |