|The Abramson Cancer Center of the University of Pennsylvania|
| Last Modified: January 23, 2012
This information is part of a process called "informed consent" to allow you to understand this study before deciding whether to take part.
The purpose of this research survey is to help understand your opinion about how your primary care doctor (family doctor or general internist) can provide the best care for you as a cancer survivor.
The information collected in this survey is confidential and the researchers will not be able to identify who is filling out the information. In the report of this study, the respondents (you) will not be recognizable and all personal health information will be protected.
This survey is for adults, 18 years of age or older, who have a diagnosis of cancer.
If you agree to be in this study, you will be asked to fill out the following brief survey.
Your participation in this study is voluntary. This means that everyone will respect your decision of whether or not you want to be in the study. No one at The University of Pennsylvania or OncoLink will treat you differently if you decide not to be in the study. If you decide to join the study now, you can still change your mind during the study. If you feel stressed during the study you may stop at any time.
The benefits of this study include generating information to better help health professionals understand how primary care doctors can provide the best care to cancer survivors. You may receive no benefit from your participation.
There will be no compensation for you or your time spent on this survey.
Contacts and Questions
Principal Investigator: Jun Mao, MD MSCE
Clinical Research Coordinator: Christina Seluzicki
All questions or other comments may be sent to:
Phone Number: 215-349-5647
If you have questions about your rights as a research subject you may contact the Office of Regulatory Affairs at 215-898-2614
Statement of Consent
I have read the above information and I feel I understand the study well enough to make a decision about my involvement.
Completion of the following survey indicates my consent to participate.