Primary Care Provider Interview Phone Recruitment Script

Form Approved

OMB No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Attachment 11

Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them

HSC-SPH-07-0187

PCP Interview Phone Recruitment Script

Hello, my name is __________. I am calling from the University of Texas M.D. Anderson Cancer Center to ask for your participation in a behavioral research study in which we are exploring patient and provider experiences with hematologic malignancies. You may have received a letter and project abstract from us in which we provided more specific information about the study, but in case you did not, I would like to tell you more about it.

We are particularly interested in understanding whether or not there are problems with any processes of patient care or delays in diagnosis and treatment. We would very much like you perspective on this issue. We will try to understand from you some specifics considerations related to hematologic malignancies such as what factors or scenarios lead a physician to recognize a patient with a malignancy, consult another physician, make a referral, and/or diagnose a hematologic malignancy. We are hoping to understand from you whether and how these processes can be problematic. For your time and the valuable information you provide, you will be given a $30 American Express gift card. Would you have about 15-20 minutes now to participate in this interview?

(If “Yes”): Great, Thank you. I would like to begin by reviewing the informed consent form and obtaining your consent to participate.

(If “No”): Is there a better time for me to call? (schedule appointment)

(For refusals): Thank you very much for your time.

Public reporting burden of this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)