Attachment A: Topic Development_Clinician Script

Script for clinician interview [topic development]

Topic of interview: [TOPIC]

Intended audience: [clinician]

Location: [enter location]

Date of the interview: [enter date]

Testing materials

• Audio recording equipment, speaker phone

• Interviewer clock

• Materials emailed to clinician 1 day before interview:

  • Consent form

• Packet of testing materials for interviewer

  • Informed consent form

Procedures for obtaining informed consent

Clinician will be sent an informed consent form before the interview. At start of interview, interviewer will ask clinician if he/she has any questions about the consent form and if agrees to be interviewed and audiotaped.

Interview goals

This information product being developed focuses on treatments for [CONDITION, TREATMENT].

Clinician will be contacted by telephone. Interviewer will ask clinician about treatments and decision making, evidence-based information/use of guidelines, and materials for patients in order to gain input for what the guide could contain and how it should be organized.

Clinician interview (30 minutes total)

Time in minutes for each section	Topic	Elapsed time at end of section
5	Introduction (welcome; background; ground rules; warm-up)	5
10	Treatments & Decision-Making	15
10	Evidence-Based Information/ Use of Guidelines	25
4	Handouts & Materials for Patients	29
1	Closing	30

Introduction (start at _____ – 5 min – end at _____)

Welcome and Background—explain purpose of the interview

• Thank you for agreeing to do this interview. My name is [NAME] and I’ll be talking with you today. I work for [ORGANIZATION NAME]. Also, on the phone with me is [NAME], who will be taking notes.

• We are currently working with the Eisenberg Center at the Baylor School of Medicine to develop a guide that summarizes the evidence of treatments for [CONDITION]. This project is sponsored by AHRQ, the Agency for Healthcare Research and Quality.

• Based on the information we get from you and others we will make recommendations to AHRQ about how to present the information.

• Did you read the consent form that was sent to you? Do you have any questions?

Go over ground rules.

• As a reminder, everything you tell us will be confidential. To protect your privacy, we won’t connect your name with anything that you say.

• Is it OK if I audiotape this interview today? {Turn on recording equipment.}

Warm-Up

I would like to begin with a couple of general background questions.

• What is your practice area?

• How many years have you been in practice?

• How would you describe your practice?

  • How many physicians and other providers does it include?

  • What is the number of patients seen per week/month/year?

  • What types of health problems you most often encounter?

• What percentage of your patients has [CONDITION]?

Treatments & decision making (10 min – end at ______)

Thank you. I would like to talk about your experiences with patients who have [CONDITION]. [NOTE: The protocol uses the term ‘patient,’ but the interviewer may choose to use parent, caregiver, guardian, or patient depending on terms the clinician uses.]

• Let’s start broadly. I’d like to know about the term [CONDITION].

  • What does it mean to you?

  • What does it include? What is not included?

• What types of treatment have you recommended for patients with [CONDITION]?

  • What factors do you consider when deciding which treatment to recommend?

  • When would you refer the patient to another clinician?

  • Who would you refer to (what types of clinicians)?

• When you recommend a treatment for [CONDITION], is there a typical first line treatment that you recommend?
  [NOTE: We want to tease out how doctors think about patients and how they work through treatment decisions with patients.  Do they use the interaction to talk the patient into a particular course of treatment, or do they have a full discussion of the options?]

  • If so, what is it? How do you discuss this with patients?

  • If not, how do you come to a decision?

• What treatment options do you typically discuss with patients? How do you explain the difference between these options? What words do you use? [IF NEEDED: If I was a patient, how would you describe these options to me?]

  • IF NEEDED: How would you describe the risks associated with each treatment? The benefits or effectiveness of each treatment?

  • What questions do patients typically ask when discussing treatment options?

  • How would you describe a typical patient’s ability to understand the difference between treatment options in terms of effectiveness and side effects?

• How involved are patients in the decision making process?

  • How would you describe your patients’ motivation to learn about [CONDITION] and the different treatment options?

  • Do patients ever bring information when they come to see you? IF YES, what types of information? Where does it come from?

  • Do patients tend to follow your recommendations for treatment? Do patients ever look for a second opinion?

  • What factors affect a patient’s ability to be involved in treatment decisions? (Probe for: age, education, literacy).

• In general, how would you describe your patients’ adherence to recommended therapies?

  • What factors influence adherence?

  • How do you find out about problems your patients may be experiencing?

Evidence-based Information/ Use of guidelines (10 min – end at ___)

• Are you familiar with the term “evidence-based medicine”?

  • (If yes) What does that mean to you?

  • Do you use evidence-based information for clinician decision making? If so how?

  • What information would help you with clinical decision making? (If necessary, give examples such as guidelines, algorithms, outcomes, side effects, cost to patients, CME, or something else).

  • Do you share evidence-based information with patients? If so, how?

  • How is your decision making for recommending a particular treatment affected when the evidence is unclear or insufficient?

  • What about when evidence-based information is different from your clinical experience? Has that ever happened? If so, what do you do? How do you share that information with patients?

• Where do you usually get evidence-based information?

  • [If typically gets from journal] When do you get a chance to read the journals? Are there other formats that would be useful to you? Would you be interested in reading summaries of the research articles, or not?

  • How would you like to get this type of information (for example, handouts, emails, Internet, CME)?

  • Are there organizations that you are affiliated with that provide this type of information?

• Are you familiar with the term “comparative effectiveness research”?

  • (If yes) What does that mean to you?

  • How is comparative effectiveness research the same or different from evidence-based information?

  • Do you use comparative effectiveness research for clinician decision making? If so, how?

• Let’s take a look at the summary guide that we sent you on [CONDITION/TREATMENT] on the second page there is an outcomes table.

  • What do you think about this outcomes chart?

  • What would you see the author’s main message is in this chart? That is what do you think they are trying to show? How well do you think the chart works to get across that message? Have you seen something like this before? If yes, please tell me about it. (Where did you see it? Who developed it? What did you think about it?) Can you think of better ways to describe this information?

  • How helpful would an outcomes chart be for you on treatments for [CONDITION]?

• How would you summarize what is currently known about the safety and effectiveness of treatments for [CONDITION]?

  • Where did you get this information?

  • Do you know of any clinical guidelines for this topic? What are they? Do you follow them? Why or why not?

  • What kinds of evidence-based information would be helpful to you in making decisions about [CONDITION] treatments? (If necessary, give examples such as outcomes, side effects, cost to patient)

• How do you learn about new ways to treat patients with [CONDITION]?

Handouts and Materials for Patients (4 min – end at ______)

Now I‘d like to talk a little bit more about your experiences communicating with your patients.

• What recommendations do you have for developing materials about treatment choices so that they are useful in helping your patients make decisions about treatments for [CONDITION]?

• Do you use handouts or information sheets when explaining treatment options for [CONDITION]?

If YES:

• Where do you usually get these materials?

• How often do you use these materials?

• In general, do the materials include text explanations or do they also have pictures or graphics?

• Would you describe these materials as evidence-based? Why or why not?

• Do you ever ask your patients if they have read the materials you provided to them?

• Do you ask if they found the materials helpful?

• Do you ask them if they have any questions about the materials you gave them? What types of questions do they ask about the information presented in the materials?

• How useful do you feel these handouts are in helping your patients understand the differences between treatment choices, such as differences between the benefits, risks, and effectiveness or different treatments?

If materials are not effective:

• Why do you feel the materials are not effective? Is the information presented in a way the patients can understand?

• How useful are the materials for patients with low reading levels? What about patients for whom English is a second language?

Closing (1 min – end at ______)

Before we end, I’d like to give you chance to share any additional thoughts or comments about the information we talked about today.

Is there anything else you would like to add that you didn’t have a chance to say during our discussion today, or something that we didn’t talk about that you wish we had?

Thank you very much for participating in this discussion today. We appreciate your time.

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