Patient Perceptions of Proton Therapy: An Internet Based Survey

This information is part of a process called "informed consent" to allow you to understand this study before deciding whether to take part.

The following survey will help us to understand common patient perceptions of proton therapy – an increasingly popular form of external radiation treatment.

This anonymous online survey contains a total of 34 multiple choice questions. There is no time limit, though some people take about 15 minutes to complete the survey.

We will collect some basic information from you such as age, income, sex, education, and the like. 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, you will not be recognizable and all personal health information will be protected.

The first part of the survey contains questions asking about your feelings towards new things. There is no right or wrong answer. The second part of the survey contains specific questions regarding your perceptions of proton therapy. We hope that the findings can help your doctors understand what patients in general think about proton therapy as a form of cancer treatment so that we can better educate patients with cancer.

Only the investigator for the study and the study team may use or share your information, and we will not disclose the information outside of the University of Pennsylvania Health System (UPHS). Should your personal health information be disclosed to others outside of UPHS, it may no longer be covered by federal privacy protection regulations. Your authorization for use of your personal health information for this specific study does not expire, though you can revoke your authorization at any time. You do this by sending written notice to the investigator for the study.

This survey is for adults, 18 years of age or older, who previously had a diagnosis of cancer. Your participation in this study is voluntary.

The benefits for taking part in this study include generating information to better help health professionals provide the best care to cancer patients. 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: Justin Bekelman, MD

Clinical Research Coordinator: (Liz) Wai Ping Ng, BS

All questions or other comments may be sent to Liz Ng at the following:

Email: waiping.ng@uphs.upenn.edu
Phone Numbers: 215-615-5645 or 215-662-4267

If you have questions about your rights as a research subject you may contact the Office of Regulatory Affairs at 215-898-2614.

Should you experience any technical difficulties, please call us at 215-615-5645. Thank you.

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.

Begin Survey


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