Appendix A - Consent Form

FDA Conference Attendees Study

Consent Form

[Consent Screen 1]

You are one of about 400 healthcare providers in the United States who are being asked to take part in a voluntary research study. In the study, you will be shown a video about a new product being promoted at a medical conference, and you will be asked questions about it. We will also ask some questions about your experiences at medical conferences. The survey will take approximately 20 minutes.

This study is being conducted by RTI International (RTI), an independent nonprofit research organization, on behalf of a public health agency. RTI is working with WebMD and Medscape to conduct this study but is not affiliated with WebMD or Medscape in any way. If you have questions about this study, please contact Mr. Doug Rupert, the project director. He can be reached between 9 AM and 5 PM Eastern Time on Monday – Friday at 1-800-334-8571 ext. 26495.

Possible Risks or Discomforts

We do not expect that any of the study questions will make you uncomfortable; however, if they do, you can refuse to answer any question. If you skip a question, you can continue with the rest of the study.

Benefits

Your responses are very important because they will help researchers understand how healthcare providers interpret information that is presented at medical conferences. There is no direct benefit to you for your participation.

Incentive

In appreciation for your time, you will receive a $50 electronic gift card for completing this study.

Rights as a Participant

If you have any questions about your rights as a participant, you may wish to contact RTI’s Office of Research Protection at 1-866-214-2043.

Privacy and Confidentiality

As with other surveys you receive from WebMD and Medscape, your information will be kept secure to the extent permitted by law. We are committed to maintaining a secure environment in which you can participate. Your name and your e‑mail address will not be shared outside of WebMD or Medscape unless required by law, and they will not be associated with your answers or used in any report.

[Consent Screen 2]

C1. If you have read the previous screen and agree to participate, please click the Yes button. If not, click the No button.

• Yes, I agree to participate. [GO TO SURVEY]

• No, I do not agree to participate. [GO TO C2]

[IF CONSENT 1 = NO OR SKIP]

C2. Are you sure you don't want to participate? Your opinions are important to us. Please select the Yes button to continue this survey. Select the No button to exit.

• Yes, I agree to participate. [GO TO SURVEY]

• No, I do not agree to participate. [TERMINATE]

Research authorized by Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 300u(a)(4)). Confidentiality protected by 5 U.S.C. 552(a) and (b) and 21 CFR part 20.

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