Form 6 Attachment F: Participant Experience Survey_Cancer Diagn

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment F: Participant Experience Survey—Cancer Diagnostic Process

Cohort

Participant Experience Survey

Cancer Diagnostic Process Cohort

Thank you for your participation in the AHRQ Safety Program for Improving the Cancer Diagnostic Process in Telemedicine (“the Safety Program”). The following questions pertain to your experience as a leader/champion, implementing the AHRQ Safety Program for Telemedicine: Improving the Cancer Diagnostic Process (“the Safety Program”). The results will be used to understand: 1) your experience using the materials provided and participating in the program and 2) how your practice approached implementation of the Safety Program including any processes used or changes made to sustain the Safety Program.

1. What is the most important change you implemented to improve the cancer diagnostic process in your practice? (open-ended response)

2. What did you or your practice measure to determine whether your cancer diagnostic process improvement goals were met? (open-ended response)

3. How did you or your practice ensure adequate support to implement the Safety Program? (open-ended response)

4. How did clinicians within your practice support implementation of the Safety Program? (open-ended response)

5. What additional content would have been helpful to include in the Safety Program?

(open-ended response)

Public reporting burden for this collection of information is estimated to average 10 minutes per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.