Screener for Primary Care Providers

Form Approved

OMB Control No. 0920-0800
Expiration Date: 1/31/2012

CENTERS FOR DISEASE CONTROL AND PREVENTION

INSIDE KNOWLEDGE FOCUS GROUP RESEARCH

WITH

PRIMARY CARE PROVIDERS (PHYSICIANS AND NURSE PRACTITIONERS)

(There is a separate, slightly different guide for gynecologists.)

Primary Care Recruitment Screener

FLUENT ENGLISH IS VERY IMPORTANT: Terminate if person’s language or other speech characteristics would make him/her difficult to understand clearly during the group; e.g., if English is not fluent.

Hello, my name is I’m with _____, a medical opinion research firm. On behalf of the federal Centers for Disease Control and Prevention or CDC, we are convening focus groups with primary care providers who provide general care for women age 40 and over. CDC will use your input in its development of a health education program for women and healthcare providers. Some of the providers I speak with today will be invited to participate in a focus group that will pay an honorarium of $200, for about 90 minutes of your time. May I ask you a few questions?

1. Note respondent gender: [Information only]

[ ] Male [ ] Female

2. Let me confirm [as appropriate for the call]:

[For physician groups] You are a PHYSICIAN, correct? [If not, terminate]

[For nurse practitioner groups] You are a NURSE PRACTITIONER, correct? [If not, terminate]

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  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: CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0800).

2. What is your primary specialty? [Recruit a mix]

Do not read except to ask about sub-specialty if they say “Internal Medicine.”

 Family Practice

 General Practice

 Internal Medicine: Do you have a sub-specialty? ______________________

Terminate if oncology/cancer or gynecology **

 Other (please specify): ___________________________ Terminate if oncology or gynecology **

**If person says “gynecology” say that there also will be separate focus groups with gynecologists. Switch to gynecology screener if possible or get time to call back to administer that screener.]

4. On average, how many hours per week do you currently spend in direct patient care?

[Terminate if fewer than 20 hours]

 0  1 to 19  20 to 39  40 or more

5. What percentage of patients you personally see are women, age 40 and over?

[Terminate if fewer than 20%]

 0%  1 to 19%  20 to 39%  40% or more

6. Are you currently serving as a clinical or research consultant to or as a board or advisory committee member for a cancer-related organization such as the American Cancer Society or others?

 Yes Terminate

 No CONTINUE

7. How about for a pharmaceutical company’s trials or products related to women’s cancers.

 Yes [What type of cancer? _______________ ] Terminate if cervical, ovarian, uterine, vaginal, vulvar, but save screener. OK for 1-2 who say breast cancer.

 No CONTINUE

8. Which best describes the setting or settings in which you practice?

[OK if respondent works in more than one setting – please note % of time in each]

[Recruit a mix; OK if not all categories are represented, but important to have a few.]

 Private solo practice

 Private single specialty group practice

 Private multi-specialty group practice

 Hospital

 Government health facility such as a VA clinic or federally qualified health center

[What type: ____________________________]

 Community health center

 College health services

 Health Maintenance Organization (HMO) or Managed Care Organization (MCO)

[No more than 1-2 per group; ideally, some groups with 0. Limit is because they are guided by

corporate policy, so will mostly say similar things about gyn care. This makes it more important for

us to hear from providers in other settings.]

 Other (please specify): ___________________________

9. Which of the following best describes the type of community where your primary practice is located? [Recruit a mix if possible.]

[ ] Urban [ ] Suburban [ ] Rural

10. Please tell me very briefly about your primary practice – a sentence or so about the types of patients you see, whether it is primarily urban, suburban, or rural…Things like that. INFORMATION ONLY. The main purpose of this question is to provider recruiters with an opportunity to detect possible problems with English fluency. Answers are of interest, but no need to get complete verbatim of response.

11. About what percentage of your patient population would you say is: RECRUIT A MIX

 Low income

 Middle income

 High income

12. Does you practice accept Medicaid? INFORMATION ONLY

 Yes

 No

 Not sure

13. Have you personally ever been diagnosed with any of any type of cancer?

 Yes:__________What kind?__________________ ____________________________

(Terminate if cervical, uterine, ovarian, vaginal, or vulvar. Otherwise, CONTINUE; note type of cancer)

 No (Continue)

14. Has a close family member ever been diagnosed with cancer.?

 Yes

[Who/type of cancer? ___________________________________]

[Recruit no more than 1-2 who have a wife, mother, sister, or daughter with cervical, ovarian, uterine, vaginal, or vulvar cancer. Several of these cancers are rare so this should not affect a lot of prospective participants. Breast cancer is OK.]

 No CONTINUE

15a. For statistical purposes, how would you describe your ethnicity? [Information only]

OK if they prefer not to answer.

1 Hispanic or Latino/Latina

2. Not Hispanic or Latino

15b. How would you describe your race? [Information Only] Please select one or more from the following response options.

OK if they prefer not to answer.

1 White

2 African American or Black

3 Asian

4 American Indian or Alaska Native

5 Native Hawaiian or Other Pacific Islander

6 Other: ____________________ [DO NOT READ THIS OPTION.]

16. How many years have you been in practice? [Information only] _________________

17. Have you participated in any focus groups or opinion interviews about cancer in the last six months?

[ ] NO Continue [ ] YES What kind of cancer? _______________

[Terminate if: ovarian, cervical, uterine, vulvar, vaginal, or “reproductive”]

INVITATION:

Thank you for answering all of my questions. We are convening small focus groups with primary care [PHYSICIANS] –OR – [NURSE PRACTITIONERS] to discuss gynecologic care for women ages 40+. You do not need to prepare for the group in any way. CDC is interested in opinions based on your unique practice experience and background.

I’d like to invite you to participate in a group.

Participants will receive $200.

Are you available?

We understand that as a healthcare provider, a lot can affect your schedule. If something comes up, please try to alert us in time to find another participant. These groups are intentionally being kept small to accommodate in-depth discussion among colleagues, so a good turn-out is even more important than with larger focus groups.

If NOT AVAILABLE, say:

Thank you for answering all my questions. I would like to invite you to take down my contact information in case you have any colleagues who may be interested in participating.

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