Form 1 Survey for Health Care Professionals

OMB #: 0925-xxxx

Expiry Date: xx/xx/20xx

NCI’s Center for Cancer Research

Survey to Assess Health Care Professionals’

Awareness of NCI Intramural Clinical Trials

The National Cancer Institute’s (NCI) Center for Cancer Research is surveying physicians and nurses in order to gain a deeper understanding of the perception that health professionals have of NCI and the services the Institute provides. The results from this survey will be used to evaluate the level of awareness and understanding of NCI’s Center for Cancer Research and to develop new programs to educate and inform healthcare professionals of their activities.

Your participation in this survey is completely voluntary. Please be assured that your responses will be kept confidential and will not be disclosed to anyone outside NCI or its contractor, Matthews Media Group (MMG), except as otherwise required by law. Data will be provided to NCI in aggregate form only, with any potentially identifying information removed. You may skip any questions that you prefer not to answer. This survey should take approximately 5 minutes to complete.

Public reporting burden for this collection of information is estimated to average 5 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). Do not return the completed form to this address.

If you have any questions or would like to know the results of the survey, please contact Angela Carrigan at acarrigan@mmgct.com or 301-348-1694.

1. Before beginning this survey, were you aware of the National Cancer Institute (NCI)?

 Yes  No

If yes, continue;

if no, skip to #4

2. How familiar are you with NCI?

 Very Familiar  Somewhat familiar  Not too familiar  Not familiar at all

Record and proceed to #3

3. What activities do you think NCI conducts or provides? (Check all that apply.)

 Defines standards of care for cancer patients

 Distributes cancer information to patients

 Distributes cancer information to physicians

 Sponsors clinical trials

 Conducts clinical trials

 Provides information about ongoing clinical trials

 Provides physicians and patients with access to thought leaders in cancer research

 Publishes journal articles

 Maintains regulatory oversight over pharmaceutical and biotechnology companies

 Collaborates with the private sector on cancer-related clinical research

 Conducts research for rare cancers typically not investigated by the private sector

 Other__________________

Record and proceed to #4

4. For each of the attributes listed below, please rank the following medical institutions in order from 1 to 6 for each characteristic. .

	Dana-Farber Cancer Institute	Fred Hutchinson Cancer Center	Kimmel Cancer Center at Johns Hopkins	M. D. Anderson Cancer Center	Memorial Sloan Kettering Cancer Center	NCI on the NIH campus in Bethesda, Md.
Cutting-edge research						
State-of-the-art technology						
Reputable						
Oncology expertise						
Industry leader						
Quality medical professionals						
Ethical						

Record and proceed to #5

5. Have you ever referred a patient to a cancer clinical trial (regardless of whether the patient was eligible and/or participated)?  Yes  No

If yes, continue;

if no, skip to #11

6. In the past year, approximately how many patients have you referred to a cancer clinical trial (regardless of whether the patient was eligible and/or participated)?

 None  1-5  6-10  11-15  16-20  21 or more

Record and proceed to #7

7. Please select the name(s) of the medical institutions to which you have ever referred a patient to a cancer clinical trial (regardless of whether the patient was eligible and/or participated)?

 Dana-Farber Cancer Institute

 Fred Hutchinson Cancer Center

 Kimmel Cancer Center at Johns Hopkins

 M. D. Anderson Cancer Center

 Memorial Sloan Kettering Cancer Center

 NCI on the NIH campus in Bethesda, Md.

 Other _________________________________________

If NCI is selected, record and proceed; if NCI is not selected, skip to #10

8. In the past year, approximately how many cancer patients have you referred to a clinical trial at NCI in Bethesda, Md. (regardless of whether the patient was eligible and/or participated)?

 None  1–2  3–5  6–10  11 or more

Record and proceed to #10

9. Have you ever referred a cancer patient to an NCI-sponsored clinical trial that was conducted at an institution or site other than NCI in Bethesda, Md. (regardless of whether the patient was eligible and/or participated)?

 Yes  No  Don’t know

Record and proceed to #11

10. How do you learn about clinical research opportunities for your patients? (Check all that apply.)

 Brochures/Flyers  Colleagues  Conferences/Seminars

 E-mail  Grand Rounds  Interdepartmental meetings  Internet  Journal articles  Mail  Newsletters  Patients

 None/Don’t learn about clinical trials  Other___________________

Record and proceed to #12

11. How do you prefer to learn about clinical research opportunities for your patients? (Check all that apply.)

 Brochures/Flyers  Colleagues  Conferences/Seminars

 E-mail  Grand Rounds  Interdepartmental meetings  Internet  Journal articles  Mail  Newsletters  Patients

 None  Other___________________

Record and proceed to #13

12. Which of these communications have you seen from NCI? (Check all that apply.)

 Brochures/Flyers  E-mail  On-line  Journal articles\News releases

 Journal ads  Mail  Newsletters  Patients

 None  Other___________________

If “None”, record and proceed to #14. Otherwise

record and proceed to #13

13. What was the overall quality of these communications from NCI?

 Poor  Fair  Good  Very good  Excellent

Please tell us about yourself.

14. What is your professional status?

 RN  RD  NP  PharmD  RPh  MD  Other________________

Record and proceed to #14

15. What is your area of specialization? (Check the one that most applies.)

 Hematology  Oncology  Radiation Oncology  Surgical Oncology

 Other_________________________________________________________________

Record and proceed to #15

16. Approximately how many cancer patients do you treat each month?

 None  1-5  6-10  11-20  21-30  31 or more

Record and proceed to #16

17. Where do you primarily practice? City:_______________________________________________________ State:______

 Outside the United States

Record and proceed to #17

18. How many years have you been working with cancer patients?

 Less than 1 year  1-2 years  3-5 years  6-10 years  11-20 years

 More than 20 years

Record and proceed to #18

19. What is your current practice setting? (Check the one that most applies.)

 Hospital inpatient  Hospital-based outpatient  Hospital-based clinic

 University  Private practice  Other____________

Record and proceed to #19

Thank you for taking the time to complete the survey. Your answers have been submitted. If you have any questions or would like to know the results of this survey, please contact Marita Lynott at 301-348-1639 or mlynott@mmgct.com.

NCI's Center for Cancer Research distributes a free quarterly e-newsletter, BethesdaTrials News, which helps community physicians stay informed of investigational approaches to treating, diagnosing, and preventing cancer. Each issue features one or more clinical trials in process at NCI on the NIH campus in Bethesda, Md.

20. Would you like to receive this e-newsletter?  Yes  No

(Check only one.)  I currently receive this e-newsletter

If yes, continue;

if no or I currently receive, skip to closing

To sign up for BethesdaTrials News, please click on the link below to be redirected to NCI's Center for Cancer Research Web site. The contact information you provide will not be linked to this questionnaire. Note that the National Cancer Institute's Center for Cancer Research does not sell or share its mailing list.

http://bethesdatrials.cancer.gov/health-care-professionals/mailinglist.asp

Thank you again for completing this survey.

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