Cognitive Interviews

Oncology Indications Study 1 Questionnaire

[Screener and consent to be inserted]

INTRODUCTION

Thank you for agreeing to participate in this study today. We are going to show you an ad with information about a prescription drug that treats a kind of cancer and then ask you some questions about it.

The survey will take about 20 minutes to complete. We ask you to complete the survey in one sitting (without taking any breaks) to avoid distractions. Your input is extremely valuable.

//NEW SCREEN//

[Display appropriate questionnaire and stimuli based on study: non-small cell lung cancer or multiple myeloma conditions]

//NEW SCREEN//

[Non-small cell lung cancer conditions]

We’d like to start by telling you a bit about a kind of cancer. It’s called non-small cell lung cancer.

Lung cancer starts when cells of the lung become abnormal and begin to grow out of control.

As more cancer cells develop, they can form into a tumor and spread to other areas of the body.

Lung cancer is the leading cause of cancer death in the United States for both men and women.

There are 2 main types of lung cancer:

• About 80% to 85% of lung cancers are non-small cell lung cancer.

• About 10% to 15% are small cell lung cancer

[Multiple myeloma conditions]

We’d like to start by telling you a bit about a kind of cancer. It’s called multiple myeloma.

Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas.

Multiple myeloma is a cancer of plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system.

In general, when plasma cells become cancerous and grow out of control, this is called multiple myeloma. It can lead to complications such as low red blood cells (anemia), more frequent infections, kidney damage, and bone pain/fractures.

While some patients may not have symptoms of multiple myeloma, for other patients the symptoms of the disease can be severe and can lead to death.

//NEW SCREEN//

[insert audio check question]

[Participants will be required to pass the audio check—indicating they are able to play videos and hear audio on their device/computer before proceeding]

//NEW SCREEN//

• Next, we will show you the TV ad.

• While you watch it, imagine that someone close to you has [non-small cell lung cancer, multiple myeloma] and you would like to learn more about their treatment options. Do your best to remember details about the ad.

• Please make sure the sound on your computer, tablet or mobile phone is turned on and your volume is turned up.

• If you are using your smartphone to take the survey, turn your phone sideways to make the ad bigger.

• The ad may take 15-30 seconds to start playing.

• Once you finish viewing the ad, please click the Continue button.

[Display appropriate stimuli based on randomized experimental condition: overall survival, overall response rate, overall response rate with disclosure, progression-free survival, progression-free survival with disclosure]

[Suppress “Continue” button until ad finishes playing]

We would like you to watch the ad a second time. Please click the Continue button to view the ad.

[Display assigned ad again] [Suppress “Continue” button until ad finishes playing]

[The audio claims to be tested were based on focus groups and may be refined during cognitive interviews. The audio claims are as follows:

Overall survival – solid tumor: In a clinical trial, patients taking Drug X lived an average of 4 months longer than patients on chemotherapy.

Overall response rate – solid tumor: In a clinical trial, 20% of patients taking Drug X had their tumors shrink or disappear, compared to 9% of patients on chemotherapy.

Progression-free survival – solid tumor: In a clinical trial, patients taking Drug X had an average of 4 months longer before their cancer grew or spread than patients on chemotherapy.

Overall survival – hematology: In a clinical trial, patients taking Drug Y in combination with dexamethasone lived an average of 4 months longer, compared to patients taking dexamethasone alone.

Overall response rate – hematology: In a clinical trial, 20% of patients taking Drug Y in combination with dexamethasone had a response such as fewer or no detectable cancer cells, compared to 9% of patients taking dexamethasone alone.

Progression-free survival – hematology: In a clinical trial, people taking Drug Y in combination with dexamethasone had an average of 4 months longer before their multiple myeloma got worse, compared to patients taking dexamethasone alone.

Disclosure: We currently do not know if [Drug X, Drug Y] helps people live longer.

//NEW SCREEN//

MANIPULATION CHECK

Question Type: Single Punch

Q1. Were you able to view the ad?

Value	Value Label
01	Yes
00	No
-99	Refused

[If Q1=00 OR Q1=-99, Terminate and show “We’re sorry, but you are not eligible for this study. Thank you for your interest in this study and for taking the time to answer our questions today.”]

//NEW SCREEN//

UNDERSTANDING/RETENTION ITEMS

Question type: Text box

Q2. What can [Drug X, Drug Y] do for people with [non-small cell lung cancer, multiple myeloma]?

[Open Field]

[Codes: cure, live longer but no cure, live longer, feel better/healthier, reduce symptoms, shrinks tumor/reduces cancer cells/improve response, extend interval between chemo, reduce cancer induced symptoms, reduce chemotherapy induced symptoms, remission, increases time without disease getting worse/cancer growing or spreading, healthier longer, less pain, other codes to be determined based on cognitive interviews and pretesting]

//NEW SCREEN//

Question Type: Grid

[Randomize order of Q3 A – F]

Q3. Based on the information in the ad, mark whether each of the statements below is true, false, or you don’t know:

Variable	Variable Text
Q3_A	[Drug X, Drug Y] can cure [non-small cell lung cancer, multiple myeloma].
Q3_B	[Drug X, Drug Y] can help people with [non-small cell lung cancer, multiple myeloma] live longer.
Q3_C	[Drug X, Drug Y] can help improve symptoms for people with [non-small cell lung cancer, multiple myeloma].
Q3_D	[Drug X, Drug Y] can help increase the amount of time before the [cancer grows or spreads, multiple myeloma gets worse].
Q3_E	[Drug X, Drug Y] can [help partially or completely shrink tumors, help increase patients’ response to treatment, such as fewer or no detectable cancer cells].
Q3_F	[Drug X, Drug Y] can improve quality of life for people with [non-small cell lung cancer, multiple myeloma].

Value	Value Label
01	True
02	False
99	Don’t Know
-99	Refused

//NEW SCREEN//

DRUG RISKS AND BENEFITS

Question Type: Grid

[Randomize order: first (00) to last (02) or last to first]

Q4. Please select one response. Based on the information in the ad, which one of the following statements is true for people with [non-small cell lung cancer, multiple myeloma]?

Value	Value Label
00	On average, people who take [Drug X, Drug Y] live the same amount of time as people who do not take [Drug X, Drug Y].
01	On average, people who take [Drug X, Drug Y] live longer than people who do not take [Drug X, Drug Y].
02	We currently don’t know whether people who take [Drug X, Drug Y] live longer or not.
99	I don’t know
-99	Refused

[If Q4=02, ask Q5]

//NEW SCREEN//

Question type: Text Box (numbers, 3 separate fields)

Q5. You mentioned that [Drug X, Drug Y] would help people with [non-small cell lung cancer, multiple myeloma] live longer. On average, how much longer do you think people with [non-small cell lung cancer, multiple myeloma] who take [Drug X, Drug Y] would live? Your best guess is fine. (Please write a number in one of the spaces below)

___ weeks longer [Q5_A] ___ months longer [Q5_B] or ___ years longer [Q5_C]

Value	Value Label
-99	Refused
-100	Valid skip

//NEW SCREEN//

QUALITY OF LIFE, SYMPTOM IMPROVEMENT, AND RISK

Question Type: Single Punch

Q6. The ad suggests that [Drug X, Drug Y] will:

Value	Value Label
01	1 Greatly reduce a person’s quality of life
02	2 Somewhat reduce a person’s quality of life
03	3 Somewhat improve a person’s quality of life
04	4 Greatly improve a person’s quality of life
05	The ad doesn’t suggest anything about quality of life.
-99	Refused

[Randomize order of Q7 – Q9]

Please indicate your level of agreement with the following statements.

//NEW SCREEN//

RISK-BENEFIT TRADEOFF

Question Type: Single Punch

Q7. The benefits of [Drug X, Drug Y] outweigh the side effects described in the ad.

Value	Value Label
01	1 Strongly disagree
02	2 Disagree
03	3 Agree
04	4 Strongly agree
99	Don’t know
-99	Refused

RISK-BENEFIT TRADEOFF

Question Type: Single Punch

Q8. [Drug X, Drug Y] is more likely to harm than benefit someone with [non-small cell lung cancer, multiple myeloma].

Value	Value Label
01	1 Strongly disagree
02	2 Disagree
03	3 Agree
04	4 Strongly agree
99	Don’t know
-99	Refused

RISK SEVERITY

Question Type: Single Punch

Q9. [Drug X, Drug Y] might have serious side effects.

Value	Value Label
01	1 Strongly disagree
02	2 Disagree
03	3 Agree
04	4 Strongly agree
99	Don’t know
-99	Refused

//NEW SCREEN//

BEHAVIORAL INTENTIONS

Question Type: Single Punch

Q10a. If a loved one was diagnosed with [non-small cell lung cancer, multiple myeloma], how likely are you to mention [Drug X, Drug Y] to him/her?

Value	Value Label
01	1 Not at all likely
02	2 Slightly likely
03	3 Somewhat likely
04	4 Very likely
-99	Refused

//NEW SCREEN//

[If Q10a>01, ask Q10b]

Q10b. If a loved one was diagnosed with [non-small cell lung cancer, multiple myeloma], I would suggest that they ask their doctor about (check all the apply):

[Randomize order]

Value	Value Label
00	Taking [Drug X, Drug Y]
01	[Drug X, Drug Y]’s risks
02	[Drug X, Drug Y]’s benefits
-99	Refused

//NEW SCREEN//

DISCLOSURE ATTENTION AND INTERPRETATION

Question Type: Single Punch

Q11 Did you see or hear this statement in the ad?

Statement:

We currently do not know if [Drug X, Drug Y] helps people live longer.

Value	Value Label
01	Yes
02	No
03	Not Sure
-99	Refused

//NEW SCREEN//

Question type: Text Box

Q11b. What does this statement mean to you?

Statement:

We currently do not know if [Drug X, Drug Y] helps people live longer.

[Codes to be determined based on cognitive interviews and pretesting]

//NEW SCREEN//

FAMILIARITY WITH CONDITION

Question Type: Single Punch

Q12. How familiar were you with treatments for [lung cancer, multiple myeloma] before today?

Value	Value Label
01	1 Not at all
02	2 A little bit
03	3 Somewhat
04	4 Quite a bit
05	5 Extremely
-99	Refused

Question Type: Single Punch

Q13. Have you ever been diagnosed as having cancer?

Value	Value Label
01	Yes
02	No (Skip to Q16)
-99	Refused

//NEW SCREEN//

Question Type: CHECKLIST

Q14. What type of cancer did you have? (check all that apply)

• Bladder cancer

• Bone cancer

• Breast cancer

• Cervical cancer

• Colon cancer

• Endometrial cancer

• Head/neck cancer

• Leukemia

• Liver cancer

• Lung cancer

• Lymphoma (either Hodgkin’s or Non-Hodgkin’s)

• Melanoma

• Multiple Myeloma

• Ovarian cancer

• Pancreatic cancer

• Pharyngeal cancer

• Prostate cancer

• Rectal cancer

• Renal cancer

• Skin cancer

• Stomach cancer

• Other cancer

Question Type: Single Punch

Q15. Did you take one or more prescription drugs for your cancer?

Value	Value Label
01	Yes
02	No
99	Don’t know
-99	Refused

//NEW SCREEN//

Q16. Are you currently caring for or making health care decisions for someone with cancer?

Value	Value Label
01	Yes
02	No
-99	Refused

//NEW SCREEN//

TREATMENT ATTITUDES

Please indicate your level of agreement with the following statements.

[The next two questions were adapted from the Schedule of Attitudes toward Hastened Death (Rosenfeld et al., 2000). Included as a potential moderator.]

Question Type: Single Punch

Q17. If I was diagnosed with a life-threatening disease, I would want to continue living no matter how much pain or suffering my disease causes.

Value	Value Label
01	1 Strongly disagree
02	2 Disagree
03	3 Agree
04	4 Strongly agree
-99	Refused

Question Type: Single Punch

Q18. If I was diagnosed with a life-threatening disease, I would aggressively pursue all possible treatments because I’d do anything possible to continue living.

Value	Value Label
01	1 Strongly disagree
02	2 Disagree
03	3 Agree
04	4 Strongly agree
-99	Refused

//NEW SCREEN//

PERSPECTIVE-TAKING

[Q19 is the perspective-taking subscale (Davis, 1983). Included as a potential moderator.]

Question Type: Grid

Q19. The following statements inquire about your thoughts and feelings in a variety of situations.  For each item, indicate how well it describes you.

Q19_A. Before criticizing somebody, I try to imagine how I would feel if I were in their place.

Q19_B. If I'm sure I'm right about something, I don't waste much time listening to other people's arguments.

Q19_C. I sometimes try to understand my friends better by imagining how things look from their perspective.

Q19_D. I believe that there are two sides to every question and try to look at them both.

Q19_E. I sometimes find it difficult to see things from the other person’s point of view.

Q19_F. I try to look at everybody's side of a disagreement before I make a decision.

Q19_G. When I'm upset at someone, I usually try to "put myself in their shoes" for a while.

Value	Value Label
01	1 Does not describe me well
02	2 Describes me a little
03	3 Somewhat describes me
04	4 Describes me well
05	5 Describes me very well
-99	Refused

//NEW SCREEN//

AD PERCEPTIONS

[Q20 targets ad perceptions, including feelings of hope, fear, worry and confusion. It was adapted from van der Meer, T. G., & Jin, Y. (2019). Seeking Formula for Misinformation Treatment in Public Health Crises: The Effects of Corrective Information Type and Source. Health communication, 1-16 and Nonnemaker, J. M., Choiniere, C. J., Farrelly, M. C., Kamyab, K., & Davis, K. C. (2014). Reactions to graphic health warnings in the United States. Health Education Research, 30(1), 46-56]

Question Type: Grid

[Randomize order of Q20A – I]

Q20. Think about the ad you just viewed. How much did the ad make you feel...?

Variable	Variable Text
Q20_A	Discouraged
Q20_B	Hopeful
Q20_C	Optimistic
Q20_D	Frustrated
Q20_E	Worried
Q20_F	Anxious
Q20_G	Scared
Q20_H	Annoyed
Q20_I	Confused

Value	Value Label
01	1 Not at all
02	2 A little bit
03	3 Somewhat
04	4 Quite a bit
05	5 Extremely
-99	Refused

//NEW SCREEN//

SELF-REPORTED ATTENTION

[Q21 was adapted from Ju, I., Ohs, J. E., & Park, J. S. (2019). Consumer’s Regulatory Knowledge of Prescription Drug Advertising and Health Risk Awareness: The Moderating Role of Risk Information Prominence. Health communication, 1-11.]

Question Type: Single Punch

Q21. How much attention did you pay to the information about the benefits of [DRUG X. DRUG Y]?

Value	Value Label
01	1 No attention
02	2 Very little attention
03	3 Some attention
04	4 A great deal of attention
-99	Refused

Question Type: Single Punch

Q22. How much attention did you pay to the information about the risks of [DRUG X. DRUG Y]?

Value	Value Label
01	1 No attention
02	2 Very little attention
03	3 Some attention
04	4 A great deal of attention
-99	Refused

//NEW SCREEN//

TELEVISION VIEWING

Question type: Single punch

Q23. In a typical week, how many hours of television do you watch?

__­­__ Hours

//NEW SCREEN//

DEBRIEF

[Drug X, Drug Y] is not a real product and is not available for sale. The purpose of this study is to learn about reactions to prescription drug information. To get a real-life reaction, we used a pretend product in this study. Please see your health care professional for questions about [lung cancer, multiple myeloma].

You have been very helpful. Thank you very much for your participation!

20