Table 5 Outline of study protocol forms and surveys and anticipated number of responses
Study protocol form/survey | Individual completing form/survey | Information obtained | Anticipated number of responses |
|---|---|---|---|
Clinic Characterization Form1 | Medical Cluster and Family Physician | Standard FOBT practice; Electronic medical record; on-site lab; solo/group practice | 50 to 80 |
Family Physician Survey2 | Family Physician | Experience with study protocol and value to clinical practice; facilitators and barriers to study collaboration; interest in future community-based primary healthcare research projects | 50 to 80 |
FOBT Completion Status Form | Family Physician | Patient FOBT status four months post requisition) | 50 to 80 |
Patient Tracking Form3 | Family Physician | Date of FOBT requisition; Patient name; FOBT kit distribution method | 1,500 to 2,400 |
In-Clinic Patient Survey4 | Patient | Age, gender, postal code, Previous FOBT screening history, internet use for health related questions; exposure to advertisements related to FOBT screening; consent for Post-Study Follow-Up Survey | 1,500 to 2,400 |
Post Study Follow-Up Survey (control)5 | Patient (10 patients per family physician) | Colorectal cancer screening and FOBT experience with family physician; FOBT test instructions; computer access frequency of use; facilitators and barriers to completing the FOBT; Personal Health Information Number | 250 to 400 |
Post Study Follow-Up Survey (intervention)6 | Patient (10 patients per family physician) | Colorectal cancer screening and FOBT experience with family physician; FOBT test instructions; computer access frequency of use; facilitators and barriers to completing the FOBT; experience with and usefulness of patient decision aids (telephone-support line and website); Personal Health Information Number | 250 to 400 |