Attachment C6_Patient Focus Groups

Health Care Systems for Tracking Colorectal Cancer Screening Tests

Focus Group Guides

Intervention Patient Focus Groups: Non-responder Focus Group (A)

Moderator Instructions: After patients (who are part of the intervention practices) sign in, they will be given a name label with identifier (A = non-responders, B = negative screen, C = positive screen). The appropriate separate groups (A, B, C) will then convene, and the group moderator will read the script below. The announcement of gift cards should be given at the end of the session. Patients in the control group practices (D) will not be divided into any further subgroups at each site. However, patients in the control practices (D) will have been previously divided into two separate groups based on whether or not they had been previously screened (e.g. one site will have patients who have been screened (D1) and the other site will have patients that have not been screened (D2).

INTRO:	Hello. My name is ______________ and I am the moderator for today’s two hour group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss colorectal cancer screening recommendations.
Moderator Info:	The Lehigh Valley Hospital EPICnet along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with individuals who were part asked to be part of our study. Your input is important to help us understand how to increase colorectal cancer screening.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after patients sign] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.

GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Let’s start off by introducing yourself to the group and tell us: - Your first name - Your favorite vacation spot

QUESTIONS:

1. Are you familiar with screening tests for colorectal cancer screening?

   1. Who do you think is supposed to receive colorectal cancer screening?

   2. Who do you think does not need to be screened for colorectal cancer?

   3. Describe to me whether you think you are someone who should receive colorectal cancer screening?

   4. Are you familiar with the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

2. Have you received colorectal cancer screening before?

   1. If so, when? How were you screened? Describe to me what influenced your decision to be screened.

   2. If you haven’t received colorectal cancer screening before, describe to me why you were not and what influenced your decision not to be screened.

3. Do you recall receiving an invitation in the mail a few months ago suggesting that you get screened for colorectal cancer screening?

   1. How did you feel about the colorectal cancer screening information that was sent to you?

      1. Did you think the information was clear? Easy to understand?

      2. What did you like about the information?

      3. What did you not like about the information?

   2. What influenced your decision to not participate?

4. Specifically in terms of this study, if it was to be conducted again and you received another invitation to get screened, what could be done differently to help encourage you to receive screening?

   1. Do you feel there was a need for better information?

   2. Do you feel there was a need for more personalized information?

   3. Do you feel there was a need for more colorectal cancer screening choices (beyond stool blood test and colonoscopy)?

   4. Do you feel you should have received direct contact from your provider?

   5. Anything else?

5. Before we end are there any issues or topics that I have not brought up today that you would like to address?

*** As a way to thank you for participating in today’s focus group, we have some gift cards for you [distribute gift cards]. Thank you again for taking the time to talk with us today. ***

Intervention Patient Focus Groups: Negative Screening Focus Group (B)

Moderator Instructions: After patients (who are part of the intervention practices) sign in, they will be given a name label with identifier (A = non-responders, B = negative screen, C = positive screen). The appropriate separate groups (A, B, C) will then convene, and the group moderator will read the script below. The announcement of gift cards should be given at the end of the session. Patients in the control group practices (D) will not be divided into any further subgroups at each site. However, patients in the control practices (D) will have been previously divided into two separate groups based on whether or not they had been previously screened (e.g. one site will have patients who have been screened (D1) and the other site will have patients that have not been screened (D2).

INTRO:	Hello. My name is ______________ and I am the moderator for today’s two hour group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss colorectal cancer screening recommendations.
Moderator Info:	The Lehigh Valley Hospital EPICnet along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with individuals who were part of our study and received a recommendation for colorectal cancer screening. Your input is important to help us understand how to increase colorectal cancer screening.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after patients sign] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.
GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Let’s start off by introducing yourself to the group and tell us: - Your first name - Your favorite vacation spot

QUESTIONS:

1. Everyone here participated in the colorectal cancer screening intervention, what did you all think about it?

   1. What were its strengths?

   2. What were its weaknesses?

2. Who do you think is supposed to receive colorectal cancer screening?

   1. Before receiving our letter, did you think you should get screened?

   2. Are you familiar with the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

3. Describe to me how often, if at all, you regularly get screened for colorectal cancer.

4. How did you feel about the colorectal cancer screening information that was sent to you a few months ago?

   1. Did you think the information was clear? Easy to understand?

   2. What did you like about the information?

   3. What did you not like about the information?

5. Tell me what motivated you to receive the recommended colorectal cancer screening?

   1. Was this something you intended to get before receiving the letter?

   2. Was this something you decided to get after you received the letter?

6. After you received the screening, how were you informed of results?

   1. Were you informed of the need for repeat screening in the future?

7. Describe to me what you thought about the process of responding to participate in this intervention.

8. Describe to me what you thought about the overall process of getting your screening.

9. Describe to me what you thought about the overall process of being notified about the screening results.

10. If you received a similar invitation in the future, tell me whether you would respond and get screened or not?

    1. Tell me more.

11. If your doctor’s office were to participate in another screening intervention program, what would you advise they do ...

    1. Differently, and why?

    2. The same, and why?

12. Before we end are there any issues or topics that I have not brought up today that you would like to address?

*** As a way to thank you for participating in today’s focus group, we have some gift cards for you [distribute gift cards]. Thank you again for taking the time to talk with us today. ***

Intervention Patient Focus Groups: Positive Screening Focus Group (C)

Moderator Instructions: After patients (who are part of the intervention practices) sign in, they will be given a name label with identifier (A = non-responders, B = negative screen, C = positive screen). The appropriate separate groups (A, B, C) will then convene, and the group moderator will read the script below. The announcement of gift cards should be given at the end of the session. Patients in the control group practices (D) will not be divided into any further subgroups at each site. However, patients in the control practices (D) will have been previously divided into two separate groups based on whether or not they had been previously screened (e.g. one site will have patients who have been screened (D1) and the other site will have patients that have not been screened (D2).

INTRO:	Hello. My name is ______________ and I am the moderator for today’s two hour group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss colorectal cancer screening recommendations.
Moderator Info:	The Lehigh Valley Hospital EPICnet along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with individuals who were part of our study and received a recommendation for colorectal cancer screening. Your input is important to help us understand how to increase colorectal cancer screening.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after patients sign] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.
GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Let’s start off by introducing yourself to the group and tell us: - Your first name - Your favorite vacation spot

QUESTIONS:

1. Everyone here participated in the colorectal cancer screening intervention, what did you all think about it?

   1. What were its strengths?

   2. What were its weaknesses?

2. Who do you think is supposed to receive colorectal cancer screening?

   1. Before receiving our letter, did you think you should get screened?

   2. Are you familiar with the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

3. Describe to me how often, if at all, you regularly get screened for colorectal cancer?

4. How did you feel about the colorectal cancer screening information that was sent to you a few months ago?

   1. Did you think the information was clear? Easy to understand?

   2. What did you like about the information? What did you not like about the information?

5. Tell me what motivated you to receive colorectal cancer screening?

   1. Was this something you intended to get before receiving the letter?

   2. Was this something you decided to get after you received the letter?

6. After you received the screening, how were you informed of results?

   1. Were you informed of the need for repeat screening in the future?

7. Describe to me what you thought about the process of responding to participate in this intervention.

8. Describe to me what you thought about the overall process of getting your screening.

9. Describe to me what you thought about the overall process of being notified about the screening results.

   1. What did you think about the timeliness of being notified of the results?

   2. Tell me about how satisfied or unsatisfied you were with the way you were notified.

   3. Tell me about your experience discussing the results with your provider.

10. Describe to me your experience of arranging a CDE.

    1. What did you think about the timeliness of arranging a CDE?

    2. During the process, were your questions about the CDE answered?

11. If you received a similar invitation in the future, tell me whether you would respond and get screened or not?

    1. Tell me more.

12. If your doctor’s office were to participate in another screening intervention program, what would you advise they do ...

    1. Differently, and why?

    2. The same, and why?

13. Before we end are there any issues or topics that I have not brought up today that you would like to address?

*** As a way to thank you for participating in today’s focus group, we have some gift cards for you [distribute gift cards]. Thank you again for taking the time to talk with us today. ***

Intervention Patient Focus Groups: Comparison – Screened – Practice Focus Group (D1)

Moderator Instructions: After patients (who are part of the intervention practices) sign in, they will be given a name label with identifier (A = non-responders, B = negative screen, C = positive screen). The appropriate separate groups (A, B, C) will then convene, and the group moderator will read the script below. The announcement of gift cards should be given at the end of the session. Patients in the control group practices (D) will not be divided into any further subgroups at each site. However, patients in the control practices (D) will have been previously divided into two separate groups based on whether or not they had been previously screened (e.g. one site will have patients who have been screened (D1) and the other site will have patients that have not been screened (D2).

INTRO:	Hello. My name is ______________ and I am the moderator for today’s two hour group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss receiving recommended colorectal cancer screening.
Moderator Info:	The Lehigh Valley Hospital EPICnet along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with individuals, such as yourselves, who were not part of our intervention, but were part of our comparison group. Your input is important to help us understand how to increase colorectal cancer screening.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after patients sign] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.
GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Let’s start off by introducing yourself to the group and tell us: - Your first name - Your favorite vacation spot

QUESTIONS:

1. Are you familiar with screening tests for colorectal cancer screening?

   1. Who do you think is supposed to receive colorectal cancer screening?

   2. Who do you think does not need to be screened for colorectal cancer?

   3. Describe to me whether you think you are someone who should receive colorectal cancer screening?

   4. Are you familiar with the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

2. How do you generally get information about colorectal cancer screening?

3. Have you received colorectal cancer screening before?

   1. If yes, when?

   2. How were you screened?

   3. Describe to me what influenced your decision to be screened?

4. Describe to me your experience with colorectal cancer screening.

   1. What about the screening process do you wish could have gone differently?

   2. What about the process would you want to stay the same?

5. In general, what do you think are ways people would be encouraged to get screened?

6. In general, what do you think are ways people would be discouraged from getting screened?

7. Before we end are there any issues or topics that I have not brought up today that you would like to address?

*** As a way to thank you for participating in today’s focus group, we have some gift cards for you [distribute gift cards]. Thank you again for taking the time to talk with us today. ***

Intervention Patient Focus Groups: Comparison – Not Screened – Practice Focus Group (D2)

Moderator Instructions: After patients (who are part of the intervention practices) sign in, they will be given a name label with identifier (A = non-responders, B = negative screen, C = positive screen). The appropriate separate groups (A, B, C) will then convene, and the group moderator will read the script below. The announcement of gift cards should be given at the end of the session. Patients in the control group practices (D) will not be divided into any further subgroups at each site. However, patients in the control practices (D) will have been previously divided into two separate groups based on whether or not they had been previously screened (e.g. one site will have patients who have been screened (D1) and the other site will have patients that have not been screened (D2).

INTRO:	Hello. My name is ______________ and I am the moderator for today’s two hour group discussion. My colleague, ______________, is here to take notes and help the session run smoothly. Our main purpose today is to discuss receiving recommended colorectal cancer screening.
Moderator Info:	The Lehigh Valley Hospital EPICnet along with the Thomas Jefferson University and The CNA Corporation conducted a study to assess an intervention to improve colorectal cancer screening and follow-up among patients 50 – 79 years old. As part of our work, we are speaking with individuals, such as yourselves, who were not part of our intervention, but were part of our comparison group. Your input is important to help us understand how to increase colorectal cancer screening.
ACKNOWLEDGE:	I want to thank you for coming in today to talk with us and for fitting this session into your already busy schedules.
DISCLOSURES:	The session is being recorded in audio to make sure our notes accurately reflect our discussion with you. I do not care who says what; I only care what gets said. Does anyone have concerns about taping this session? Notes will also be taken during the discussion today, but they will not include any identifying information about the group’s participants.
INFORMED CONSENT:	Your decision to participate in this study is voluntary. Before we begin, I would like to hand out this consent form for you all to sign, if you still would like to participate in our discussion. [hand out informed consent, and collect after patients sign] - Are there any questions about your participation in this study? - If you do not want to participate in this study, please take this time to gather your things and leave the room.
GUIDELINES:	A few guidelines before we start: 1. What you say in this room stays in this room. As I already mentioned, all information discussed today will be held in confidence. So, please feel comfortable in speaking openly and candidly with us. 2. Please talk one at a time. 3. Talk in a voice as loud as mine. 4. Avoid side conversations with your neighbors; but it is okay to “piggy back” on comments others have made. Just be sure to talk loud enough so the whole group can participate. 5. Make sure everyone has a chance to talk. 6. There is no one point of view, please allow all points of view to be heard. 7. Say what you believe, it doesn’t matter whether or not anyone agrees with you.
QUESTIONS:	Are there any other questions before we begin?
SELF INTROS:	Let’s start off by introducing yourself to the group and tell us: - Your first name - Your favorite vacation spot

QUESTIONS:

1. Are you familiar with screening tests for colorectal cancer screening?

   1. Who do you think is supposed to receive colorectal cancer screening?

   2. Who do you think does not need to be screened for colorectal cancer?

   3. Describe to me whether you think you are someone who should receive colorectal cancer screening?

   4. Are you familiar with the new 2008 American Cancer Society Colorectal Cancer Screening Guidelines?

2. How do you generally get information about colorectal cancer screening?

3. Have you received colorectal cancer screening before?

   1. If you haven’t received colorectal cancer screening before, describe to me why you were not and what influenced your decision not to be screened.

4. Has your provider ever suggested that you should be screened?

1. If yes, describe to me what you did after talking with your provider.

2. If no, how would you feel if your provider suggested screening?

5. In general, what do you think would encourage you to get screened?

6. In general, what do you think would discourage you from getting screened?

7. Before we end are there any issues or topics that I have not brought up today that you would like to address?

*** As a way to thank you for participating in today’s focus group, we have some gift cards for you [distribute gift cards]. Thank you again for taking the time to talk with us today. ***

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