Prenotification Letter Research Articles

Community pharmacist encounters with patients displaying suicide warning signs: a cross-sectional survey

BackgroundMental health is a prominent public health issue exacerbated by the coronavirus disease 2019 pandemic. Community pharmacists are positioned to contribute. ObjectivesThis study aimed to describe Iowa community pharmacists’ encounters, confidence, behaviors, and training needs related to patients with suicide warning signs and explore relationships between demographics and previous training with encounter frequency, confidence, and behaviors. MethodsA cross-sectional survey was mailed to a sample of community pharmacists in Iowa. Three contacts were made between May and June 2022 including a prenotification letter, survey with a paid return envelope, and reminder postcard, each with a QR code for optional online completion. The survey included demographics, suicide warning sign encounter types, confidence, suicide prevention behaviors, and suicide prevention training history and needs. Analysis of variance and t tests compared differences between demographics and previous training with encounter frequency, confidence, and behaviors. ResultsThe response rate was 18.3% with 161 survey completions. Pharmacists reported encounters with patients who appeared distressed (96.3%), made concerning statements related to suicide (23.8%), and disclosed suicidal thoughts (8.8%). A minority of pharmacists had asked patients about suicide (21.1%) or referred them to crisis resources in the past year (17.4%). A third had previous suicide prevention training (37.9%), which was associated with higher levels of confidence (P < 0.001) and intervention behaviors (P < 0.05). Respondents expressed interest in training, particularly on intervention and referral. ConclusionsThis sample of community pharmacists encountered patients with suicide warning signs. Providing more pharmacists with training and support in understanding local mental health resources and referrals may increase their confidence and engagement in suicide prevention.

Pre-notifications increase retention in a 17-year follow-up of adolescents born very preterm

ObjectiveRetention is essential in follow-up studies to reduce missing data, which can cause bias and limit the generalizability of the results. We investigated whether pre-notification letters would increase the response rates of approval forms and questionnaires and reduce the need for post-notifications in a prospective follow-up study of 17-year-old adolescents.Study designand settingsThis long-term follow-up study included 269 adolescents were randomized (1:1) into a pre-notification group (n = 132) and a no pre-notification group (n = 137). The pre-notification letter was sent prior to the approval form and questionnaires. The outcome measures were the response rates to the approval forms and questionnaires and the rate of post-notifications required.ResultsThe adolescents who received the pre-notifications were more likely to return approval forms (n = 88/132, 67%) than the adolescents who did not receive the pre-notifications (n = 79/137, 58%) (OR 1.5, 95% CI 0.9–2.4). The rates of returned questionnaires were higher in the pre-notification group (n = 82/88, 93%) than in the no pre-notification group (n = 68/79, 86%) (OR 2.2, 95% CI 0.8–6.3). The adolescents who did not receive the pre-notifications were more likely to need the post-notifications than the adolescents who received the pre-notifications (OR 3.0, 95% CI 1.4 to 6.5).ConclusionsPre-notifications decreased the need for post-notifications and may increase retention in 17-year-old adolescents. Based on our findings, pre-notification letters are recommended in future follow-up studies in adolescents.Trial registrationThe Ethics Review Committee of the Hospital District of South-West Finland approved the 17-year PIPARI Study protocol in January 2018 (23.1.2018; 2/180/2012). The study has been registered to the SWAT repository as SWAT 179. Filetoupload,1457904,en.pdf (qub.ac.uk).

Randomised evaluation of pre-notification of trial participants before self-report outcome data collection to improve retention: SWAT86

Background Retention is considered the second highest trial methods priority in the UK after recruitment. There is limited evidence on whether notifying trial participants that a follow-up questionnaire will be sent soon (‘pre-notification’) affects retention. Methods This Study Within a Trial (SWAT) evaluated whether sending a pre-notification letter or email around 2 weeks before sending a self-report questionnaire increased retention, in terms of provision of the host trial primary outcome. The SWAT was a randomised, two-arm, parallel-design (1:1 allocation ratio) trial, controlled by ‘no pre-notification letter’. It was embedded within the WORKWELL host trial, which evaluated the impact of job retention vocational rehabilitation on work-related and health-related outcomes of employed people with inflammatory arthritis. The SWAT primary outcome was a valid response for the WORKWELL primary outcome. Results Two hundred forty-four trial participants took part in the SWAT. All were included in the analysis. Among those sent a pre-reminder, 100/121 (83%) provided a valid response for the WORKWELL primary outcome, compared to 97/123 (79%) of those not sent a pre-reminder. The estimated adjusted odds ratio was 1.28 (95% confidence interval 0.67–2.42), with a risk difference of 3.8% (95% CI -6.1 to 13.6%), favouring the prereminder. The estimated intervention cost per additional participant retained was £53.42, and the total cost per additional participant retained was £46.52. Conclusion Researchers may have a small improvement in trial retention by using pre-notification. The cost per additional participant retained is relatively low. However, further evaluations are merited.

Effect of prenotification on the response rate of a postal survey of emergency physicians: a randomised, controlled, assessor-blind trial

ObjectivesResponse rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey...

Simplified Notifications Improve Response Rates to Patient Surveys: Findings from the Medicare Disenrollment Survey Experiment

Research ObjectiveResponse rates to patient surveys used to evaluate the quality of care have declined in recent years. We assessed several strategies to improve survey response rates, specifically the use of shorter, simpler, more motivational text as recommended by Dillman (2018) (ie, how completing the survey would help other beneficiaries choose plans) in prenotification and cover letters and streamlining the front‐end screener items that assess survey eligibility.Study DesignIn the context of the 2018 Medicare Advantage (MA) Disenrollment Reasons Survey, a monthly survey of disenrollees from MA plans, we implemented a three‐arm randomized experiment (using randomized block design) blocked by MA plan. (1) The control arm (N = 43,277) received the standard survey with prenotification and cover letters. (2) Experimental arm 1 (N=2,484) received the standard survey with modified prenotification and cover letters. (3) Experimental arm 2 (N = 2,484) received the standard survey with streamlined screener questions and modified prenotification and cover letters. We used regression modeling to compare response rates by arm, adjusting for person‐level characteristics (age, gender, dual eligibility for Medicare and Medicaid or low‐income supplement eligibility, and rurality as defined by Beale Code) and fixed effects for MA plan. The disenrollment survey protocol consists of a prenotification letter followed by a mailed survey with cover letter; nonrespondents receive a second mailed survey with cover letter.Population StudiedRandom sample of 48,245 Medicare beneficiaries who voluntarily disenrolled from a Medicare Advantage plan in December 2018 and were mailed a disenrollment reasons survey to complete in February‐March 2019.Principal FindingsAdjusted response rates were 2.3‐2.5 percentage points higher in each experimental arm (33.2% and 33.0%)) than in the standard arm (30.7%). Thus, overall, the experimental arm modifications increased response rates by 2.4 percentage points (95% CI: [1.1‐3.7], (P &lt; .001). Adjusted response rates did not differ between the two experimental arms (P = 0.895). Response rates were lower for beneficiaries &lt;65 years of age, and for dually eligible beneficiaries, but did not differ by gender or rurality.ConclusionsShorter, simpler, and more motivating prenotification and cover letter language, that provided the clear purpose of the survey and value of providing feedback to assist other beneficiaries like themselves in making plan selections, significantly improved response rates in the disenrollment survey at no additional cost. Such modifications may encourage response by reducing the time and complexity for disenrollees to read and understand the survey material. Streamlined screening questions did not further increase response rates, suggesting format or complexity of screening logic may be a less critical factor in response rates than the initial decision to participate based on the initial materials.Implications for Policy or PracticeImprovements to invitational materials to participate in patient surveys can boost response rates at no additional cost, which is important in an environment of declining response rates and limited resources for data collection.Primary Funding SourceCenters for Medicare and Medicaid Services.

Paper, E-mail, or Both? Effects of Contact Mode on Participation in a Web Survey of Establishments

Identifying strategies that maximize participation rates in population-based web surveys is of critical interest to survey researchers. While much of this interest has focused on surveys of persons and households, there is a growing interest in surveys of establishments. However, there is a lack of experimental evidence on strategies for optimizing participation rates in web surveys of establishments. To address this research gap, we conducted a contact mode experiment in which establishments selected to participate in a web survey were randomized to receive the survey invitation with login details and subsequent reminder using a fully crossed sequence of paper and e-mail contacts. We find that a paper invitation followed by a paper reminder achieves the highest response rate and smallest aggregate nonresponse bias across all-possible paper/e-mail contact sequences, but a close runner-up was the e-mail invitation and paper reminder sequence which achieved a similarly high response rate and low aggregate nonresponse bias at about half the per-respondent cost. Following up undeliverable e-mail invitations with supplementary paper contacts yielded further reductions in nonresponse bias and costs. Finally, for establishments without an available e-mail address, we show that enclosing an e-mail address request form with a prenotification letter is not effective from a response rate, nonresponse bias, and cost perspective.

Perceptions of organizational culture and organizational citizenship by faculty in U.S. colleges and schools of pharmacy

Objectives(1) Describe perceptions of organizational culture and prevalence of organizational citizenship behaviors (OCBs) among faculty at United States (U.S.) colleges/schools of pharmacy; (2) determine which aspects of those phenomena are strongest and which are most problematic; (3) evaluate the psychometric properties of measures for organizational culture and OCBs in academic pharmacy; and (4) identify any relationships between organizational culture and organizational citizenship among academic pharmacy faculty. MethodsA random sample of 600 U.S. academic pharmacists acquired from the American Association of Colleges of Pharmacy were distributed an email survey through the use of Qualtrics technology. The procedures closely resembled the Total Design Method advocated to maximize survey response, including use of a pre-notification letter, reminders, and a nominal financial inducement. In addition to demographic questions, the survey employed multiple-item measures of organizational culture and OCBs described previously in the literature and derived from Delphi consensus-building procedures. The analysis plan incorporated use of factor and item analyses to evaluate psychometric properties of the measure and elicit the inherent domains comprising these phenomena, along with descriptive statistics to describe facets of organizational culture and OCBs that were most prevalent. ResultsA total of 177 responses were delivered. Factor analysis of organizational culture revealed a five-factor solution emphasizing achievement orientation, professionalism, stability, supportiveness, and reflectiveness. OCB domains were along the possibility of faculty being virtuous, disrespectful, sportsmanlike, and benevolent/malevolent. Even while multi-faceted and avoiding a simple typological descriptor, academic pharmacy cultures were reportedly healthy. Sportsmanship, while still somewhat commonly observed, was seen less frequently than other behaviors. The measures demonstrated logical, cogent factor structures and excellent internal consistency reliability. ConclusionsPsychometrically well-performing measures were used to assess the multi-faceted organizational culture of academic pharmacy programs and the organizational citizenship behaviors of its constituent faculty. The results can be used to measure these phenomena at individual organizations for benchmarking and to inform future inquiries that can assist with development of strategies that impact academic worklife and outcomes.

Mobile Apps for Behavioral Health: A Survey on User Engagement

Background: The number of mobile app interventions for behavioral health has grown exponentially over the last decade. A recent study by the IMS Institute for Healthcare Informatics found that health and wellness apps available to consumers more than doubled between 2013 and 2015, from 43,000 to over 90,000. Despite their availability, mobile app interventions are not yet offered or encouraged routinely in behavioral health treatment planning. One possible reason for minimal implementation is limited knowledge of patient preferences regarding use of these interventions. Objective: The current study seeks to increase knowledge in three key areas related to mobile app interventions designed specifically to address a key area of behavioral health: depression and/or anxiety. Depression and/or anxiety were selected as the focus for this project given that these mental health disorders affect over a quarter of the US population and are highly comorbid. Key research questions include (1) What are the demographics of patients who are most interested in using mobile app interventions for depression and/or anxiety? and (2) What are the reasons patients endorse for disinterest in mobile app interventions for depression and/or anxiety? Methods: Potential participants were identified at random from a list of veterans diagnosed with a mood and/or anxiety disorder (per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) who attended a primary care appointment during 2014 at a Veterans Affairs Medical Center located in a major metropolitan area of the northeastern United States. A total of 400 potential participants are being mailed a brief (15 minute) survey. A modified Dillman method is being used in which a prenotification letter is mailed out to participants, followed by the survey with an opt-out form, followed by up to two additional mailings for those potential participants who do not respond. Results: Data collection is expected to be complete in late August of 2016. The poster proposed here will include findings from descriptive analyses on use of technology (smart phones, mobile apps in general, mobile apps for any behavioral health concern, and mobile apps for depression and/or anxiety) in different demographics. Additionally, descriptive data on reasons endorsed for low willingness to use mobile app interventions for depression and/or anxiety (when recommended by a health care provider as well as when accessed independently) will be presented. Finally, findings from analyses evaluating the relationship between demographic variables (race, gender, education, age, and symptom severity) and level of interest in mobile app interventions for depression and/or anxiety will be presented. Conclusions: The target audience for mobile app interventions for depression and/or anxiety and reasons patients may choose not to use these interventions will be identified. Limitations include using a veteran-only sample and focusing exclusively on interventions for depression and anxiety rather than other areas of behavioral health. Future research should seek to build upon findings by broadening the scope of investigation to civilians and other areas of behavior change. Findings from this study can inform healthcare providers and app developers on patient preferences regarding mobile app interventions. [iproc 2016;2(1):e42]

Pre-notification letter type and response rate to a postal survey among women who have recently given birth.

BackgroundSurveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper evaluates a strategy to increase the response rate in a postal satisfaction survey with women who had recently given birth.MethodsA sample of 2048 Australian women who had recently given birth at seven maternity units in New South Wales were invited to participate in a postal survey about their recent experiences with maternity care. The study design included a randomised controlled trial that tested two types of pre-notification letter (with or without the option of opting out of the survey). The study also explored the acceptability of a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). This consent was requested of all women.ResultsThe survey had an overall response rate of 46 % (913 completed surveys returned, total sample 1989). Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women declining were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97 % gave consent to link their survey data with existing health data.ConclusionsThe two types of pre-notification letters used in our study did not influence the survey response rate. However, seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.

Forewarned is Forearmed? A Survey-Experiment concerning the Impact of Pre-Notification Letters on Response in a Postal Survey

The use of pre-notification letters is thought to increase the response rate of postal surveys. The empirical evidence for that claim, however, is not conclusive. In this research note we assessed the impact of pre-notification by means of data from a large-scale survey-experiment conducted in Flanders (N: 4000). Three outcomes were studied: overall response rate, timing of the response and quality of the response. No significant positive impact was found on the overall response rate and quality of response. However evidence indicated that respondents who received a pre-notification letter were more inclined to respond earlier.

A prenotification letter increased initial response, whereas sender did not affect response rates

ObjectiveTo find ways to improve response rates of medical and health surveys. We investigated whether a prenotification letter instead of a second reminder and varying senders of the questionnaires would affect response rates. Study Design and SettingWe present the results of two studies. In the first study, four groups were compared that either received a prenotification letter (group 1 and 2) or a second reminder letter (group 3 and 4); received the questionnaire from either a research institute (group 1 and 3) or a health insurance company (HIC; group 2 and 4). In the second study, we compared two groups that received the questionnaire sent by either a HIC or a hospital. Response rates, response speed, respondent characteristics, item nonresponse, and mean scores on quality aspects and global ratings were compared. ResultsResponse rates did not differ significantly between groups. Prenotification groups returned their questionnaires faster. No other significant differences were found for response speed, respondent characteristics, item nonresponse, or mean scores. ConclusionA prenotification letter does only increase initial response speed and does not increase total response rates. A prenotification letter should be considered when quick response is desirable. Varying senders had no effect on response rates.

An International View of How Recent‐onset Atrial Fibrillation Is Treated in the Emergency Department

This study was conducted to determine if there is practice variation for emergency physicians' (EPs) management of recent-onset atrial fibrillation (RAF) in various world regions (Canada, United States, United Kingdom, and Australasia). The authors completed a mail and e-mail survey of members from four national emergency medicine (EM) associations. One prenotification letter and three survey letters were sent to members of the Canadian Association of Emergency Physicians (CAEP; Canada-1,177 members surveyed), American College of Emergency Physicians (ACEP; United States-500), College of Emergency Medicine UK (CEM; United Kingdom-1,864), and Australasian College for Emergency Medicine (ACEM; Australasia-1,188) as per the modified Dillman technique. The survey contained 23 questions related to the management of adult patients with symptomatic RAF (either a first episode or paroxysmal-recurrent) where onset is less than 48 hours and cardioversion is considered a treatment option. Data were analyzed using descriptive and chi-square statistics. Response rates were as follows: overall, 40.5%; Canada, 43.0%; United States, 50.1%; United Kingdom, 38.1%; and Australasia, 38.0%. Physician demographics were as follows: 72% male and mean (±SD) age 41.7 (±8.39) years. The proportions of physicians attempting rate control as their initial strategy are United States, 94.0%; Canada, 70.7%; Australasia, 61.1%; and United Kingdom, 43.1% (p < 0.0001). Diltiazem is the predominant agent for rate control in Canada (65.36%) and the United States (95.22%), while metoprolol is used in Australasia (65.94%) and the United Kingdom (67.64%). Cardioversion is attempted at varying rates in Canada (65.9%), Australasia (49.9%), United Kingdom (49.5%), and the United States (25.9%) (p < 0.0001). Pharmacologic cardioversion is attempted first in all regions, with the preferred drug being procainamide in Canada (61.93%) and amiodarone in Australasia (63.39%), the United Kingdom (47.97%), and the United States (22.41%; p < 0.0001). If drugs fail, electrical cardioversion is then attempted in Canada (70.64%), Australasia (46.19%), the United States (29.69%), and the United Kingdom (27.78%; p < 0.0001). There is much variation in emergency department (ED) management of RAF among world regions, most markedly for use of rate versus rhythm control, choice of drugs, and use of electrical cardioversion. Canadians are more likely to use an aggressive approach for management of RAF, whereas Americans are more likely to employ conservative management. U.K. and Australasian EPs fall somewhere in the middle. These differences demonstrate the need for better evidence, or better synthesis of existing knowledge, to create guidelines to guide ED management of this common dysrhythmia.

Prenotification, Incentives, and Survey Modality: An Experimental Test of Methods to Increase Survey Response Rates of School Principals

Teacher and principal surveys are among the most common data collection techniques employed in education research. Yet there is remarkably little research on survey methods in education, or about the most cost-effective way to raise response rates among teachers and principals. In an effort to explore various methods for increasing survey response rates, we randomly assigned 1,177 high school principals in the state of Michigan to 1 of 4 experimental conditions. We varied the mode of survey delivery, the mode in which the prenotification letter was sent, and whether or not a $10 incentive was provided. The results indicate that providing a monetary incentive substantially increased response rates over the no incentive condition and that principals were more likely to respond to a paper-based survey than a web-based one.

Is this Subarachnoid Hemorrhage Significant? A National Survey of Neurosurgeons

Previously all subarachnoid hemorrhage (SAH) patients were admitted, whereas now patients with angiography may be discharged. To survey neurosurgeons to determine current practice and what constitutes a clinically significant subarachnoid hemorrhage. We surveyed all neurosurgeons listed in the Canadian Medical Directory. We used a modified Dillman technique with up to five mailed surveys plus a pre-notification letter. Neurosurgeons rated the significance of 13 scenarios of subarachnoid hemorrhage. Scenarios varied from aneurysmal subarachnoid hemorrhage to patients with isolated xanthochromia in cerebrospinal fluid. Each scenario was rated for clinical significance using a 5-point scale [1(always) to 5(never)]. Of the 224 surveyed, 115 neurosurgeons responded. Scenarios with aneurysms requiring intervention, arteriovenous malformations, death or any surgical intervention all had median responses of 1 (IQR 1, 1). Scenarios having xanthochromia and few red blood cells in cerebrospinal fluid with negative computerized tomogram (CT) and angiography had median responses of 3 (IQR 1, 4). Scenarios with perimesencephalic pattern on CT with negative angiography had median of 3 (IQR 2, 4). Scenarios where patient is discharged from the emergency department had median of 4 (IQR 3, 5). Subarachnoid hemorrhages due to aneurysms or arteriovenous malformations causing death or requiring surgical intervention are always clinically significant. Other types of nonaneurysmal subarachnoid hemorrhages had inconsistent ratings for clinical significance. These survey results highlight the need for further discussions to standardize the diagnosis of what constitutes a clinically significant subarachnoid hemorrhage and what care should be afforded to these patients.

No difference demonstrated between faxed or mailed prenotification in promoting questionnaire response among family physicians: a randomized controlled trial

ObjectiveAchieving high survey participation rates among physicians is challenging. We aimed to assess the effectiveness of response-aiding strategies in a postal survey of 1,000 randomly selected Australian family physicians (FPs). Study Design and SettingA two×two randomized controlled trial was undertaken to assess the effectiveness of a mailed vs. faxed prenotification letter and a mailed questionnaire sealed with a label marked attention to doctor vs. a control label. At the time of our final reminder, we randomized remaining nonresponders to receive a more or less personalized mail-out. ResultsResponse did not significantly differ among eligible FPs receiving a prenotification letter via mail or fax. However, 25.6% of eligible FPs whose questionnaires were sealed with a label marked attention to the doctor responded before reminders were administered and compared with 18.6% of FPs whose questionnaires were sealed with a control label (P=0.008). Differences were not statistically significant thereafter. There was no significant difference in response between FPs who received a more vs. less personalized approach at the time of the final reminder (P=0.16). ConclusionMail marked attention to doctor may usefully increase early response. Prenotification letters delivered via fax are equally effective to those administered by mail and may be cheaper.

Survey of emergency physicians’ requirements for a clinical decision rule for acute respiratory illnesses in three countries

ABSTRACTObjective:There are currently no widely used guidelines to determine which older patients with acute respiratory conditions require hospital admission. This study assessed the need for clinical decision rules to help determine whether hospital admission is required for patients over 50 years for three common respiratory conditions: chronic obstructive pulmonary disease (COPD), heart failure (HF), and community-acquired pneumonia (CAP). Postal survey. Emergency physicians (EPs) from the United States, Canada, and Australasia. A random sample of EPs from the United States, Canada, and Australasia. A modified Dillman technique with a prenotification letter and up to three postal surveys. EP opinions regarding the need for and willingness to use clinical decision rules for emergency department (ED) patients over 50 years with COPD, HF, or CAP to predict hospital admission. We assessed the required sensitivity of each rule for return ED visit or death within 14 days. A total of 801 responses from 1,493 surveys were received, with response rates of 55%, 60%, and 46% for Australasia, Canada, and the United States, respectively. Over 90% of EPs reported that they would consider using clinical decision rules for HF, CAP, and COPD. The median required sensitivity for death within 14 days was 97 to 98% for all conditions. EPs are likely to adopt highly sensitive clinical decision rules to predict the need for hospital admission for patients over 50 years with COPD, HF, or CAP.

Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer

To determine whether differences in attitude and practice between physiatrists and oncologists exist that may be barriers to patients with advanced cancer receiving rehabilitation services. A survey of medical oncologists' and rehabilitation physicians' self-reported referral attitudes and behaviors regarding rehabilitation services for patients with advanced cancer defined as the prognosis expected to lead to death in 6-12 months. After a prenotification letter, surveys were mailed to a systematically drawn sample. A final survey population of 591 medical oncologists and 464 rehabilitation physicians was created from prenotification and survey mailings. Practicing physiatrists and oncologists listed in the American Academy of Physical Medicine and Rehabilitation and American Society of Clinical Oncology membership directories. Responses to survey questions by physiatrists and oncologists. From 820 surveys mailed, 395 surveys were returned, for a total response rate of 46%. When asked about how a terminal prognosis of patients with advanced cancer affects rehabilitation referral and acceptance, only 8% of medical oncologists said that they would refer a patient with advanced cancer to rehabilitation services regardless of estimated prognosis, whereas 35% of rehabilitation physicians said that they would accept a patient with advanced cancer for rehabilitation services regardless of prognosis. Approximately 70% of both medical oncologists and rehabilitation physicians thought it to be very important that patients with advanced cancer who are referred and accepted into rehabilitation services adequately understand their prognosis before beginning a rehabilitation program. However, only 39% of rehabilitation physicians, compared with 61% of medical oncologists, believed that patients with advanced cancer and in rehabilitation services adequately understood their prognosis (P = .004). As surveyed, a do not resuscitate order had no effect on a medical oncologist's willingness to refer a patient with advanced cancer to rehabilitation services and had minimal effect on a rehabilitation physician's willingness to accept a patient with advanced cancer. Medical oncologists and rehabilitation physicians share many similar attitudes with regard to the referral and acceptance of patients with advanced cancer for rehabilitation services. However, medical oncologists see prognosis as a more significant barrier to rehabilitation services than do rehabilitation physicians. Rehabilitation physicians are more likely to believe that the patients with advanced cancer for whom they care do not adequately understand their prognosis.

The Use of Cognitive Interviewing to Explore the Effectiveness of Advance Supplemental Materials among Five Language Groups

Prior research has shown that the use of a prenotification letter is effective in improving mail survey response rate. However, little is known about whether an advance supplemental brochure will have a similar effect. The research documented in this article serves two purposes: First, this exploratory study uses qualitative data from cognitive interviews conducted with five language groups to understand why a multilingual brochure inserted with an English advance letter might or might not enhance survey participation among non-English-speaking respondents. Second, this research highlights the issues in analyzing secondary data collected using cross-cultural cognitive interview methods in which the interviews have been conducted, translated, interpreted, and summarized by language experts into English summaries.

Effects of Incentives and Prenotification on Response Rates and Costs in a National Web Survey of Physicians

Little is known about what strategies are cost-effective in increasing participation among physicians in surveys that are conducted exclusively via the web. To assess the effects of incentives and prenotification on response rates and costs, general internists (N = 3,550) were randomly selected from the American Medical Association (AMA) Masterfile and assigned to experimental groups that varied in the amount of a promised incentive (none, entry into a $200 lottery, $50, or $100) and prenotification (none, prenotification letter only, or prenotification letter containing a $2 preincentive). Results indicated that the response rates were highest in the groups promised $100 and $50, respectively. While the postal prenotification letter increased response rates, the inclusion of a small token $2 preincentive had no effect on participation. Further, unlike mail surveys of physicians, the $2 preincentive was not cost-effective. Among physicians, larger promised incentives of $50 or $100 are more effective than a nominal preincentive in increasing participation in a web-only survey. Consistent with prior research, there was little evidence of nonresponse bias among the experimental groups.

Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: A survey of the American Academy of Family Physicians (AAFP).

9128 Background: Little is known about primary care physicians’ attitudes and knowledge regarding the health and long term follow-up (LTFU) of childhood cancer survivors (CCS). We sought to obtain family physicians’ (FPs) self-reported preferences and knowledge regarding this population. Methods: Following a pre-notification letter, surveys with a $2 bill were mailed to 1520 physicians from the AAFP membership directory in November 2010. A second mailing to non-responders is ongoing. Results: To date, 529 FPs have responded (35% response rate). Respondents have practiced a median of 25 years and see a median of 80 patients/week. In the last five years, 63% had seen at least one CCS in their practice; about half (54%) report almost never receiving a treatment summary. Among 3 specific cancer types, respondents’ discomfort in caring for CCS (1 = very uncomfortable; 7 = very comfortable) was greatest for osteosarcoma survivors (3.2 ± 1.7), less with ALL survivors (3.3 ± 1.7), and least with Hodgkin lymphoma (HL) survivors (mean ± SD 3.6 ± 1.7). The majority (82%) prefer to care for CCS in consultation with a cancer center based physician and/or LTFU clinic. A vignette of a 29-year-old female treated for HL with mantle radiation at age 16 was provided, participants were asked a series of follow-up monitoring questions. Concordance of responses to the Children’s Oncology Group LTFU Guidelines was: breast cancer surveillance, 18%; cardiac surveillance; 10%, and thyroid surveillance, 71%. Only 3% were concordant with all three of these questions. Concordance with breast cancer and cardiac questions was associated with reported familiarity with guidelines (OR=3.49, 95% CI 1.79-6.78; OR=3.73, 95% CI 1.73-8.04, respectively). In describing what would be most useful to care for CCS (1=not at all useful; 5=very useful), among 11 options, FPs reported the most preferred were access to LTFU guidelines (4.7 ± 0.6) and a patient-specific care plan (4.7 ± 0.6). Conclusions: While the majority of FPs are willing to follow CCS, they express some discomfort with this care, appear unfamiliar with the available LTFU guidelines and prefer to follow patients in collaboration with a cancer center.