Form 3 LiveHelp Questionnaire

APPENDIX 1B REVISED

(October, 2012)

EXAMPLE OF LIVEHELP TRANSCRIPT AND

LIVEHELP QUESTIONS

CUSTOMER SERVICE AND DEMOGRAPHICS QUESTIONS –

TEXT AND SCREENSHOTS

DATA COLLECTION INSTRUMENTS AND

ELECTRONIC CONTACT RECORD FORM (ECRF)

STARTED	: Mon Feb 01 22:17:40 EST 2010
AGENT	: Information Specialist
ID	: chat_NG9G24G3Q8694SHS
DURATION	: 29 mins. 29 secs.

22:19:00 CA_176200 > My fraternal twin brother has liposarcoma cancer. Is it possible I also have it? Is there a test I can take to check for it?
22:19:45 Information Specialist> Thank you for contacting us with your question. I am sorry to hear about your brother's diagnosis. I can certainly look in the resources of the National Cancer Institute (NCI) to see what we have to assist you. More coming...
22:22:33 Information Specialist> Thank you for waiting. It will be just another moment while I type up some information from our resources.
22:26:40 Information Specialist> Thank you for your patience. According to our resources, liposarcoma is one type of a group of cancers called soft tissue sarcoma. There are some types of cancer that have a hereditary component (meaning that having a relative with the same type of cancer may increase your risk of developing the same type of cancer). Doctors often cannot explain why one person develops cancer and another does not. But research shows that certain risk factors increase the chance that a person will develop cancer. Because your twin brother has liposarcoma does not mean that you have or will ever have liposarcoma. For more information about soft tissue sarcoma's, including risk factors, you may wish to review the following resource:

http://www.cancer.gov/cancertopics/factsheet/sites-types/soft-tissue-sarcoma

22:27:40 Information Specialist> You may also want to tell your doctor that your brother has been diagnosed with liposarcoma and discuss if this puts you at a greater risk than the general public of developing this cancer.
22:28:45 Information Specialist> Please let me know if this information is helpful and if you have any questions.
22:33:38 CA_176200 > Yes this information is very helpful. My brother has had three surgeries to remove this cancer. One last January, then in May and July. They have found more suspicous masses since during an x-ray. I am not sure what there next step will be. I have just been very concerned I may also have it since we are twins. would you know of a place that specializes in this type of cancer and a phone number I can call?
22:37:43 Information Specialist> Although we do not categorize hospitals by specialty, we can provide information on NCI-designated Cancer Centers which treat all kinds of cancer. There may be specialists within these hospitals that have a special interest in treating this type of cancer. A physician would be in the best position to answer this question. We do have information on locating a doctor or treatment facility for cancer treatment that you may want to review at the link below:

http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility

You may also wish to contact the Sarcoma Alliance which provides guidance, education, and support to sarcoma patients.
Sarcoma Alliance
Phone: 415-381-7236
http://www.sarcomaalliance.com
22:40:18 Information Specialist> I do want to clarify that just because your twin brother has been diagnosed, does not mean that you have this cancer. Most cancers develop because of changes (mutations) in genes. A normal cell may become a cancer cell after a series of gene changes occur. Tobacco use, certain viruses, or other factors in a person's lifestyle or environment can cause such changes in certain types of cells. Some gene changes that increase the risk of cancer are passed from parent to child. These changes are present at birth in all cells of the body. Our information does not specifically say that family history is a risk factor for liposarcoma. For more general information about risk factors for cancer, you may want to look at the following resource.

http://www.cancer.gov/cancertopics/wyntk/cancer/allpages#144a8fff-dabc-4ac8-a92d-c554dd164545

22:42:09 CA_176200 > Thank you for your help. I have read a lot of information on this type of cancer, but have been unable to find out any information about possible having it myself. So thank you again for the web sites and phone numbers.
22:43:33 Information Specialist> You are very welcome. If you don't have any more questions before you go, may I ask you a few questions to help us evaluate our program and see whom we are serving? Your response will be completely confidential.

22:44:15 CA_176200 > sure.

22:44:28 Information Specialist> Have you used our service before?

22:44:42 CA_176200 > No.
22:44:45 Information Specialist> Thank you. I'm sending you a link to the rest of the questions. By clicking on this link you will open the questions in another window on your computer. If you cannot open the link, please let me know and I can open it for you on your computer.

https://cissecure.nci.nih.gov/demo/demographics.asp?USID=US1405607153

Thank you in advance for answering these questions and for using the NCI's LiveHelp service. Please don't hesitate to contact us again in the future if you need further assistance.

22:47:07 Information Specialist> Attention! Agent left this chat room. It will be closed soon

*** CHAT IS DONE ***

NOTEPAD

Customer Service Questions

Customer Service Questions Asked of CIS Client:

1. Have you used our service before?

2. How did you find our number to call?

3. What is your zip code?

Demographic Survey Text

Top of Form

What is your age?

Age

Don’t know

What is your Sex?

Male

Female

Which of These Ethnicities Best Describes You?

Hispanic or Latino

Not Hispanic or Latino

Which of These Races Best Describes You? You can select more than one:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

What Is the Highest Level of Education You Have Completed?

Grade school

Some high school

High school graduate

Some college

College graduate

Post-graduate

Not sampled

Refusal

Did not ask

Don’t know

Did not complete

Is There a Place You Usually Go to When You are Sick or Need Advice About Your Health?

Yes

No

Don't Know

Did not complete

Not sampled

Refused

Did not ask

What Kind of Place Do You Go Most Often?

A doctor’s office

A clinic, health center, or hospital clinic

The emergency room, or

Some other place

No one place

Valid skip

Don’t know

Did not complete

Not sampled

Refused

Did not ask

In the Last 12 Months, Did You Have Any Kind of Healthcare Coverage, Including Health Insurance, Prepaid Plans Such As HMOs or Government Plans Such as Medicare?

Yes

No

Don’t know

Did not complete

Not sampled

Refused

Did not ask

Would You Say You Had This Coverage During All 12 Months or Less Than 12 Months?

All 12 months

Less than 12 months

Valid skip

Don’t know

Did not complete

Not sampled

Refused

Did not ask

Which Type of Coverage Did You Have?

Was it public, such as Medicare, Medicaid, or other government plans?

Was it private, such as an HMO, Blue Cross, Kaiser, Aetna?

Or, was it both public and private?

Valid skip

Don’t know

Did not complete

Not sampled

Refused

Did not ask

The final questions are about your family income. I understand that this is sensitive information and I would like to stress again that all of the information you provide is confidential. What Was Your Total Household Income from All Sources Before Taxes Last Year? Just Stop Me When I Get to the Right Category

Less than $10,000

$10,000 to $19,000

$20,000 to $29,000

$30,000 to $39,000

$40,000 to $59,000

$60,000 to $79,000

$80,000 or more

Don’t know

Did not complete

Not sampled

Refused

Including Yourself, How Many People Living in Your Household are Supported by This Total Household Income?

Total People

Valid skip

Don’t know

Did not complete

Not sampled

Refused

Did not ask

Demographic Survey Screen Shots

Note: The Information Specialist only asks callers their age. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers their gender. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers whether they are Hispanic or Latino or Not Hispanic or Latino. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers their heritage (first 5 options). The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers their level of education. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers if there is a specific place they go to for medical advice. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers where they go for medical advice. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers if they have healthcare coverage including health insurance, prepaid plans such as HMOs, or government plans such as Medicare. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers whther or not the have had coverage for 12 months or less than 12 months. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers what type of coverage they have/had. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers their income range. The other radio buttons are only for internal coding.

Note: The Information Specialist only asks callers how many people live in their household that are supported by their total household income. The other radio buttons are only for internal coding.

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