OCS_#24_Attach4 Consent_In-person_4-10-2013

Attachment 4. Consent Form

Identification of Project	Needs Assessment for the NCI Office of Cancer Survivorship’s Website
Statement of Age of Subject	I state that I am at least 18 years of age, in good physical health, and wish to participate in a program of research being conducted by the Division of Cancer Control and Population Sciences (DCCPS) Office of Cancer Survivorship (OCS) at the National Cancer Institute, Bethesda, MD 20742.
Purpose	This test will help to determine the usability and effectiveness of OCS’ website, to ensure that it provides relevant, easy-to-access content for researchers, advocates, health care providers, and the general public in a manner that is compliant with best practice guidelines and standards, and that it aids in the dissemination of information on a broad range of survivorship topics.
Procedures	Participants will perform information-seeking tasks on existing or proposed web pages or other materials and be asked about their thoughts and opinions related to how information is presented on the OCS website (http://cancercontrol.cancer.gov/ocs/). The total time involved, including instructions, will be no more than 60 minutes.
Confidentiality	All information collected in this study will be kept secure to the extent permitted by law. I understand that the data I provide will be grouped with data others provide for the purpose of reporting and presentation and that my name will not be used. I understand that the session will be audiotaped and my computer usage (mouse clicks) will be electronically recorded, but my face will not be videotaped. My voice and computer usage recording will not be played to others aside from the research team without my written permission. The recordings will be kept in a locked cabinet and will be destroyed by December 31, 2015.
Risks	I understand that the risks of my participation are expected to be minimal in nature.
Benefits, Freedom to Withdraw, & Ability to Ask Questions	I understand that this study is not designed to help me personally but that the investigators hope to gain a better understanding of OCS audience segments, and make improvements to the content, structure and presentation of standard pages on cancer.gov. I am free to ask questions or withdraw from participation at any time and without penalty.
Contact Information of Investigators	Julia H. Rowland and Nicole Saiontz DCCPS Office of Cancer Survivorship National Cancer Institute 6116 Executive Boulevard MSC 8336, Suite 404 Rockville, Maryland 20852 E-mail: [email protected]

Printed Name of Research Participant _____________________________

Signature of Research Participant ________________________________

Date______________________

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