FDA Opioids Communications Project
Chronic Opioid Patients Screening Questionnaire [email/phone]
Part 1: Quintiles Healthcare Engagement & Communications
Subject: Online Focus Group about Prescription Pain Medications
Hello, Quintiles Healthcare Engagement & Communications invites you to participate in an upcoming focus group about prescription pain medications that is being sponsored by the U.S. Food and Drug Administration, or FDA.
The focus group will be conducted online by a third party, RTI International. RTI is an independent, non-profit research organization. The focus group will last about 90 minutes. You will receive $75 in appreciation for your time. To see if you are eligible, please complete the brief survey below. If eligible and interested, your information will be shared with itracks, a research firm that will be scheduling the groups. All of your responses will be kept private and your image will not appear online during the focus group so the moderator and other people participating will not be able to see you.
Have you been taking any of these drugs on a regular basis for the past three (or more) months to treat non-cancer pain? By a regular, we mean daily or on most days.
|
Yes |
No |
Alfentanil (Alfenta) |
|
|
Buprenorphine (Belbuca, Bunavail, Buprenex, Butrans, Suboxone, Zubsolv) |
|
|
butorphanol |
|
|
Codeine (Fioricet w/ codeine, Fiorinal w/ codeine, Tylenol w/ codeine) |
|
|
Dihydrocodeine (Synalgos-DC) |
|
|
Fentanyl (Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Sublimaze, Subsys) |
|
|
Hydrocodone (Anexsia, Hysingla ER, Lortab, Norco, Reprexain, Vicodin, Vicoprofen, Zohydro ER) |
|
|
Hydromorphone (Dilaudid, Dilaudid-HP, Exalgo) |
|
|
Meperidine (Demerol) |
|
|
Methadone (Dolophine, Methadose) |
|
|
Morphine (Astramorph PF, Duramorph PF, Embeda, Infumorph, Kadian, Morphabond, MS Contin) |
|
|
oxycodone (Oxaydo, Oxycet, Oxycontin, Percocet, Percodan, Roxicet, Roxicodone, Xartemis XR) |
|
|
oxymorphone (Opana, Opana ER) |
|
|
pentazocine (Talwin) |
|
|
remifentanil (Ultiva) |
|
|
sufentanil (Sufenta) |
|
|
tapentadol (Nucynta, Nucynta ER) |
|
|
tramadol (Conzip, Ultracet, Ultram, Ultram ER) |
|
|
Are you available to participate in a group at either of the following times:
TIME 1: Y/N
TIME 2: Y/N
Thank you for answering our questions. If you are eligible to participate someone from itracks will call you to complete the screening process and answer any questions that you have about the study.
Part 2: itracks
Hello, my name is _______________ and I’m calling from the research firm called itracks. You recently responded to an email from Quintiles Healthcare Engagement & Communications indicating you were interested in participating in an upcoming online focus group on prescription pain medications sponsored by the U.S. Food and Drug Administration, or FDA. The focus group will be conducted by RTI International, an independent, non-profit research organization. The focus group will take about 90 minutes and you will receive $75 in appreciation for your time. We will take every precaution to protect your privacy. Participants will be asked not to share any information outside of the group and no one outside of Quintiles Healthcare Engagement & Communications and itracks will have your personal information. The focus group discussion will be conducted online using audio only so no one will see you and you won’t see other people. The discussion will be audio recorded and transcribed, but we will not include your name or other identifying information in the transcription or project report.
To confirm your eligibility to participate in this research study, I need to ask you a few questions. All of your responses will be kept private.
May I proceed?
Yes CONTINUE
No END [Thank respondent and end call.]
You previously indicated that you are available to participate in a group at [TIME 1] and/or [TIME 2]. Do those times still work for you?
Yes CONTINUE
No END [Thank respondent and end call.]
How old were you on your last birthday?
_____ |
Over Age 18 CONTINUE Under Age 18 TERMINATE |
SCREEN FOR A MIX OF AGES |
Are you a medical or health professional?
Yes |
|
TERMINATE |
No |
|
CONTINUE |
Have you ever worked for…? [Read the options below]
Department of Health and Human Services |
|
TERMINATE |
U.S. Food and Drug Administration |
|
TERMINATE |
Pharmaceutical company |
|
TERMINATE |
itracks |
|
TERMINATE |
RTI International |
|
TERMINATE |
None of the above |
|
CONTINUE |
Have you ever been prescribed any of the following opioids to manage non-cancer pain? [Read options below and record yes or no for each]
|
Yes |
No |
Alfentanil (Alfenta) |
|
|
Buprenorphine (Belbuca, Bunavail, Buprenex, Butrans, Suboxone, Zubsolv) |
|
|
butorphanol |
|
|
Codeine (Fioricet w/ codeine, Fiorinal w/ codeine, Tylenol w/ codeine) |
|
|
Dihydrocodeine (Synalgos-DC) |
|
|
Fentanyl (Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Sublimaze, Subsys) |
|
|
Hydrocodone (Anexsia, Hysingla ER, Lortab, Norco, Reprexain, Vicodin, Vicoprofen, Zohydro ER) |
|
|
Hydromorphone (Dilaudid, Dilaudid-HP, Exalgo) |
|
|
Meperidine (Demerol) |
|
|
Methadone (Dolophine, Methadose) |
|
|
Morphine (Astramorph PF, Duramorph PF, Embeda, Infumorph, Kadian, Morphabond, MS Contin) |
|
|
oxycodone (Oxaydo, Oxycet, Oxycontin, Percocet, Percodan, Roxicet, Roxicodone, Xartemis XR) |
|
|
oxymorphone (Opana, Opana ER) |
|
|
pentazocine (Talwin) |
|
|
remifentanil (Ultiva) |
|
|
sufentanil (Sufenta) |
|
|
tapentadol (Nucynta, Nucynta ER) |
|
|
tramadol (Conzip, Ultracet, Ultram, Ultram ER) |
|
|
Yes (to one or more) |
|
CONTINUE TO Q5 |
No |
|
CONTINUE [ASK Q5A] |
Have you been taking [DRUGS FROM Q4 THAT R SAYS YES TO] on a regular basis for the past three (or more) months to treat your non-cancer pain? By regular, I mean daily or on most days.
Yes |
|
CONTINUE |
No |
|
TERMINATE |
What is your gender? [Ask only if necessary]
Male |
|
CONTINUE |
Female |
|
CONTINUE |
SCREEN FOR APPROXIMATELY ½ OF EACH |
Do you live in a rural, suburban, or urban setting?
Rural |
|
CONTINUE |
Suburban |
|
CONTINUE |
Urban |
|
CONTINUE |
SCREEN FOR A MIX |
Are you Hispanic or Latino? (Monitor distribution to ensure we have diversity as close to U.S. distribution as possible)
Yes |
|
CONTINUE |
No |
|
CONTINUE |
SCREEN FOR A MIX |
Which of these groups best describes you? You may answer more than one. (Monitor distribution to ensure we have diversity as close to U.S. distribution as possible).
White |
|
CONTINUE |
Black / African American |
|
CONTINUE |
American Indian or Alaskan Native |
|
CONTINUE |
Asian |
|
CONTINUE |
Native Hawaiian or Pacific Islander |
|
CONTINUE |
Other |
|
CONTINUE |
Two or more races |
|
CONTINUE |
SCREEN FOR A MIX |
In which State of the U.S. do you live
____________ |
|
CONTINUE |
SCREEN FOR A MIX BASED ON THE FOLLOWING REGIONS: Northeast: (1) New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont); (2) Mid-Atlantic (New Jersey, New York, and Pennsylvania) South: (1) South Atlantic (Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, Washington D.C., and West Virginia); (2) East South Central (Alabama, Kentucky, Mississippi, and Tennessee); (3) West South Central (Arkansas, Louisiana, Oklahoma, and Texas) Midwest: (1) East North Central (Illinois, Indiana, Michigan, Ohio, and Wisconsin); (2) West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota) West: (1) Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming); (2) Pacific (Alaska, California, Hawaii, Oregon, and Washington) |
What is the highest level of education you have attained? (Monitor distribution to ensure we have some lower education participants as close to US distribution as possible)
Less than high school |
|
CONTINUE |
High school graduate (or GED) |
|
CONTINUE |
Some college or technical school (No degree) |
|
CONTINUE |
College graduate (2- or 4-year degree) |
|
CONTINUE |
Some graduate school (No degree) |
|
CONTINUE |
Graduate school degree |
|
CONTINUE |
SCREEN FOR A MIX OF THE FOLLOWING:
|
Invitation for Eligible Participants
Thank you for answering all of my questions. We would like to invite you to take part in the study.
The discussion will last up to 90 minutes. This is a study related to prescription pain medications. Your participation will help us better understand the issues that we will discuss. No one will attempt to sell you anything, and no one will call you for other studies as a result of your participation. In appreciation for your time, you will receive $75 after the group. This is an important research effort, and we hope that you will be part of it. I also want to remind you that the focus groups will be audio-recorded and transcribed. The audio files will be shared only with the project team, including the FDA, but will not include any identifying information.
Can we schedule your attendance?
Yes CONTINUE
No [Thank respondent and end call]
Are you available to participate in a group at either of the following times:
TIME 1: Y/N
TIME 2: Y/N
NOTE: ONLY ONE PARTICIPANT PER FAMILY SHOULD BE RECRUITED ACROSS THE ENTIRE STUDY
We will be sending you instructions for accessing the focus group so before we end the call, I’d like to confirm your contact information [Complete Participant Information on last page].
Finally, we will be sending you two copies of a consent form that includes more information about the research study. You MUST return a signed copy of this consent form in order to participate in the focus group. I can either mail them to you and provide a postage-paid envelope for you to send a signed copy back to us, or I can email them to you and you can either email a scanned copy back to us or fax it to us. Which method do you prefer?
IF MAIL
OK, I will mail you two copies of the consent form. Please read and sign one copy of the consent form and return it to us prior to [DATE OF GROUP]. We will provide a postage-paid envelope for you to send it to us. The other copy is for you to keep. Please remember that we must receive the signed consent form from you in order to participate in the group.
If
you have any questions about the information in the consent form, you
can contact Lauren McCormack at 919-541-6277 or by email at
lmac@rti.org
IF EMAIL
I will send you the consent forms by email to [email address].
Follow-up Email Text
Subject: Online Focus Group about Prescription Pain Medication
Thank you for agreeing to participate in our focus group. In order to be able to participate in the group we must receive a signed copy of this form from you prior to [DATE OF GROUP]. Please keep a copy of the form for your records.
Instructions for Returning the Consent Form
You can send a scanned copy of the signed form to monica.grebe@itracks.com.
You can fax a signed copy of the form to [FAX # for RECRUITER]
If
you have any questions about the information in the consent form, you
can contact Lauren McCormack at 919-541-6277 or by email at
lmac@rti.org
Follow-up Mail Text
Dear [NAME]:
Thank you for agreeing to participate in the online focus group about prescription pain medications. I have included two copies of the consent form for this study. In order for you to be able to participate, we must receive a signed copy of this form from you before the focus group scheduled on [DATE OF GROUP]. Please return one signed copy of the form in the enclosed postage-paid envelope and keep the second copy for your records.
If you prefer, you can email a scanned copy of the signed form to monica.grebe@itracks.com or you can fax a signed copy to [FAX # for RECRUITER].
If
you have any questions about the information in the consent form, you
can contact Lauren McCormack at 919-541-6277 or by email at
lmac@rti.org
Thank you,
RECRUITER
Closing for Ineligible Participants:
I’m sorry, but you are not eligible for this study. There are many possible reasons why people are not eligible. These reasons were decided earlier by the researchers. However, thank you for your interest in this study and for taking the time to answer our questions today.
Focus Group Log-In Information (to be sent by email)
Subject: Online Focus Group about Prescription Pain Medication
Dear
[FULLNAME]:
Thank you for agreeing to participate in
our focus group study. This email includes information on how to join
the focus group.
Before the research starts please take a few minutes to test the link below to make sure that you are able to login successfully. You will not be able to join the discussion unless our system shows that you have done this.
You
can do the test at any time by logging in and clicking on your
project [INCLUDE NAME OF LINK]. Our system will check to make sure
that everything is working properly. If you have issues doing your
check you can call the itracks help desk at any time at
1-888-525-5026 ext. 2 during the week, ext. 7 on weekends.
You
will also need to call in by phone for the audio portion of the focus
group. This
information will be shown to when you log in at the time of the focus
group.
The focus
group is scheduled for 90 minutes,
so please be sure to allocate enough time in your schedule to
accommodate the entire session.
The details
below are what you need to login. When you log in for the first time,
you will be asked to create a password. Be sure to write it down so
that you do not forget it. After the initial registration, you
must enter your Email Address and Project ID exactly as shown to
access the session.
Thank
you and we look forward to your participation!
Project
Date & Time: [STARTDATE]
Email
Address: [EMAIL]
Password: (you
create this the first time you log in)
Project
ID: [PROJECTSUPPORTID]
Login
Page URL: [LOGINURL]
If
you have any questions regarding this, please feel free to reply to
this email.
Confirmation Call
Hello this is [NAME] calling from itracks regarding an online focus group you recently agreed to participate in.
I’m calling to make sure you received the instructions for logging into the focus group that we sent by email and that you are still willing to participate.
Have you received the instructions? [Wait for answer]
IF NO – Note in sheet and tell participant you will re-send.
And are you still planning on participating? [Wait for answer]
IF NO: Do you have a specific question or concern that I can address about the study? [IF NOT THANK PARTICIPANT FOR THEIR TIME]
IF YES:
[CHECK TO SEE IF CONSENT FORM WAS RECEIVED. IF NOT REMIND PARTICIPANT TO SEND SAYING: I see you haven’t returned a signed copy of the consent form to participate. Please send us that [in the postage-paid envelope provide before your focus group or by email or fax]. You will not be able to participate in the study if we don’t receive it.
Ending:
Great. Do you have any other questions at this time?
Thank you [NAME]. We appreciate your participation in this study.
Reminder Call: Consent
Initial reminder call to be made 3 days after the consent is sent if by email, 1 week if by mail. Additional follow-up calls to be made one day after the participant said they would send it.
After two reminder calls and/or 3 days prior to group itracks and RTI will discuss whether to replace participant.
Hello this is [NAME] calling from itracks regarding an online focus group about prescription pain medications that you recently agreed to participate in.
I’m calling because we have not received a signed copy of the study consent form yet. You will not be able to participate in the focus group unless we receive it before the group is scheduled on [DATE OF GROUP].
Are you still planning to participate in the group?
IF NO: Do you have a specific question or concern that I can address about the study? [IF NOT THANKK PARTICIPANT FOR THEIR TIME]
IF YES:
Will you be able to return it to us today? [IF NOT, ASK WHEN]. Will you be mailing it, sending it by email, or fax?
Great, I will make a note of when we can expect it.
Thank you [NAME]. We appreciate your participation in this study.
Reminder Calls
If participant has not logged in for the group 10 minutes prior to the start time.
When calling out to someone for reminders:
Hello this is [NAME] calling from itracks regarding the online study you recently agreed to participate in. We noticed you have not logged in yet and wanted to check in to see if you were still planning on participating. With studies like this it is important we get the opinions of everyone selected to participate so we can get many different views on the issue. There is still time for you to participate. Are you still able to join us?
IF YES – confirm and thank
Ending:
IF
YES
- We will look for you in the study. Any questions at this time?
IF
NO
– Well, thank you for your time.
Participant Information (screener to collect on initial screening call)
NAME: ________________________________________________________
ADDRESS: ________________________________________________________
CITY: ________________________________________________________
ZIP CODE: ________________________________________________________
EMAIL ________________________________________________________
What is the best time to reach you? What is the best telephone number to reach you at that time?
BEST TIME TO BE REACHED: ________________________________________
BEST PHONE NUMBER: ______________
Is there another time and number we can try if we miss you?
ALTERNATE PHONE NUMBER:
Recruiter: ____________________
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | FDA Online Study |
Author | Jackie Amoozegar |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |