Form 1 Attachment B Telephone Screener

4/13/2015 OMB #: 0925-xxxx, Expiration Date: xx/xxxx

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private to the extent provided by law.  Names and other identifiers will not appear in any report of the study. Information provided will be combined for all study participants and reported as summaries.  You are being contacted by mail to complete this instrument so that we can understand how genomic testing results are used to inform cancer treatment.

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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX).

NATIONAL CANCER INSTITUTE PRECISION MEDICINE STUDY

Telephone Script

Template for Institutional Contactors

General Instructions

Please note that the numbers provided to you are not a direct line to the doctor, but rather a general number to the office. The purpose of this call is to verify that the doctor works there and to obtain his/her contact information so we can reach him/her directly. Please listen carefully to the options provided to you when you call the general number. In most cases, you will want to select the option that directs you to the front desk, receptionist. If those options are not available, and nobody answers immediately, select the option to talk to an on-call nurse.

If at any point the call is cut short, try to:

• find a good time to call back,

• provide your phone number to call back, or

• offer to call back at a more convenient time.

INITIAL RESPONSE AFTER DIALING OFFICE NUMBER

Receptionist (or other staff) answers		 CONTINUE TO INTRODUCTION
Receptionist (or other staff) not at desk, goes to voicemail		 LEAVE MESSAGE (INTRODUCTION) AND SAY YOU WILL CALL BACK
Automated response provides options		 SELECT OPTION (IF AVAILABLE) TO SCHEDULE AN APPOINTMENT OR SPEAK WITH A NURSE After selecting your option, If someone answers, continue to Introduction If you are directed to voicemail, leave message (introduction) and say you will call back.
Disconnected number, personal residence (not of sample member), or non-medical organization		 ELIGIBILITY UNKNOWN, ROUTE CASE TO TRACING
Busy signal		 SET CALLBACK

INTRODUCTION

Hello, this is (CALLER’S NAME), calling from [Institution] on behalf of Dr. [NCI NAME] at the National Cancer Institute.

We are conducting a national study of precision medicine in cancer treatment. Dr. [RESPONDENT NAME] was selected to participate in this important study. I just need to verify that Dr. [RESPONDENT NAME] works here and that I have his or her contact information correct.

[IF NEEDED:] This study involves a 20-minute survey that Dr. [RESPONDENT NAME] can complete at his/her convenience. It is about the use of genomic testing in cancer treatment. We’d like to contact him/her directly so we can invite him/her to participate in the study.

RESPONDENT SCENARIOS (Follow script based on most relevant scenario.)

Scenario 1: Respondent is unwilling to continue with the call

1. Is there a better time I can call back?

OK to call back		 OK, we will call back on [date/time]. Thank you. [END CALL]
DON’T call back		 [TRY TO CONTINUE AND FIND SOMEONE WHO CAN HELP]

2. Is there someone else I could talk to? [If yes] can you please connect me or provide the phone number? We just need to verify that Dr. [NAME] works here and confirm his mailing address, phone number, and e-mail address.

Yes, connects/forwards while still on the line (ask for phone number in case of disconnection): __________________		 CONTINUE TO SCENARIO 2
Yes, provides phone number: __________________		 CALL NEW NUMBER AND START OVER WITH SCRIPT
No (i.e., no other person who can talk)		 [THANK AND END CALL]

Scenario 2: Respondent offers to connect you to a different number [try to get phone number in case you are disconnected]

Connection goes through and someone picks up		 START OVER FROM INTRODUCTION
Connection goes through but goes to voicemail		 LEAVE MESSAGE (INTRODUCTION) AND SAY YOU WILL CALL BACK
Connection goes through but nobody answers and there is no answering machine		 END CALL AND SCHEDULE A CALL BACK FOR NEW NUMBER
Connection fails, or number provided is not a working number		 END CALL AND SCHEDULE A CALL BACK FOR ORIGINAL NUMBER
Automated response provides options		 SELECT OPTION (IF AVAILABLE) TO SCHEDULE AN APPOINTMENT OR SPEAK WITH A NURSE After selecting your option, If someone answers, continue to Introduction If you are directed to voicemail, leave message (introduction) and say you will call back.

Scenario 3: Respondent is willing to continue

1. Can you verify that Dr. [NAME] works here?

Yes		 CONTINUE
Unsure		 Go to Scenario 1B (to find someone who might know the answer)
No, does not work here		 ELIGIBILITY UNKNOWN. Route to TRACING
No longer works here		 ELIGIBILITY UNKNOWN. Obtain name and address of new work location or route to TRACING
N/A, retired		INELIGIBLE
N/A, deceased
N/A, other reason (fill in): ________

2. What is Dr. [NAME]’s specialty? Is s/he a…

Medical oncologist		 ELIGIBLE, CONTINUE
Hematologist (or Hem-Onc)		 ELIGIBLE, CONTINUE
Hematologist/oncologist		 ELIGIBLE, CONTINUE
Oncology, non-specific		 ELIGIBLE, CONTINUE
Other non-oncology (fill in): ____________		INELIGIBLE
Don’t know		 Go to Scenario 1B (to find someone who might know the answer)
Refuses to provide		 Go to Scenario 1B (to find someone who might know the answer)

3. Thank you. What is the telephone number for Dr. [NAME]? [If necessary, clarify that we’d like to reach Dr. [NAME] directly about the study.]

Confirms phone number on file is best/correct		 CONTINUE
Provides new phone number (enter below and repeat back): _________________		 CONTINUE
Don’t know		 Go to Scenario 1B (to find someone who might know the answer)
Refuses to provide		 Go to Scenario 1B (to find someone who might know the answer)

4. Thank you. Can I just verify Dr. [NAME]’S business practice mailing address? We have [ADDRESS ON FILE] listed as Dr. [NAME]’s mailing address. Is that the best address to use?

Confirms address on file is best/correct		 CONTINUE
Provides updated address information (enter below and repeat back):		 CONTINUE
Don’t know		 Go to Scenario 1B (to find someone who might know the answer)
Refuses to provide		 Go to Scenario 1B (to find someone who might know the answer)

5. Thank you. Finally, what is Dr. [NAME]’s e-mail address? We’d like to be able to invite him/her to participate via e-mail.

Provides email address (enter below and repeat back):		 Go to G
Don’t know		 Go to F
Refuses to provide		 CONTINUE

6. Is there someone else I could talk to? [If yes] can you please provide the phone number?

Yes		 RECORD and go to G to terminate call. Begin at introduction with new contact.
No		 Go to G
Don’t know		 Go to F
Refuses to provide		 CONTINUE

7. Thank you very much for talking to me today. We appreciate your help!

END CALL