Physician Survey Regarding Cervical Cancer Screening

Thank you for taking the time to fill out this survey. The data will be used to assess the viability of a self-administered cervical cancer screen.
1. Which of the following best describes your area of practice?
OB/Gyn
Internist
Family practitioner
General practitioner
Other (please specify):
2. How long have you been a practicing physician? years
3. How many licensed physicians are in your practice (including yourself)?
4. Which of the following best describes the location of your practice? Urban
Suburban
Rural
5. In a typical week, approximately how many pap smear samples do you collect yourself? samples
Comments (optional):
6. In a typical week, approximately how many pap smear samples are collected in your office by physician's assistants and/or nurses working under your direction? samples
Comments (optional):
7. What is your standard charge for an office visit that includes a pap test? $/visit
Comments (optional):
8. What is your typical reimbursement for an office visit that includes a pap test? $/visit
Comments (optional):
9. How often do you use ThinPrep for the pap test samples collected in your office? Always
Sometimes
Never
Comments (optional):
Thank you for providing this background information. Answer the remaining questions assuming that the "home cervical cancer screen" is an FDA-approved product that is at least as accurate as a traditional pap smear, that is as easy to use as a home pregnancy test, and that requires a sample to be shipped to a lab for analysis. Assume the method for preparing and shipping the analysis to the lab is foolproof.
10. If this home cervical cancer screen was available over-the-counter, how likely would you be to tell your patients about it without them asking?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
Comments (optional):
11. If a patient asked you about this product, how likely would you be to discourage its use?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
Comments (optional):
12. If a patient had no risk factors for disease, how likely would you be to discourage her from having a checkup only once every three years, and to self-administer a cancer screen using this product once a year between these visits?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
How likely would you be to discourage her from having a checkup only once every two years, and to self-administer a cancer screen using this product once a year between these visits?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
Comments (optional):
13. If a patient was using a highly accurate blood test to detect ovarian cancer at least once per year, was regularly and properly conducting a self-exam of her breasts, and had no risk factors for other diseases, how likely would you be to discourage her from having a checkup only once every three years, and to self-administer a cancer screen using this product once a year between these visits?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
How likely would you be to discourage her from having a checkup only once every two years, and to self-administer a cancer screen using this product once a year between these visits?

Not Likely

 1 2 3 4 5

Very Likely

 Don't Know
Comments (optional):
14. What would be your primary concerns about recommending this product to your patients?

15. What do you see as the primary benefits of a reliable, self-administered home cervical cancer screen?

16. Would you be willing to answer additional questions about your practice and this product in the future? Yes
No
17. If you answered yes to the previous question, please provide your email address and/or a daytime phone number:

Email address:

Daytime phone number:
18. Do you have any additional comments/thoughts about this product based on the information provided in this survey?

Thank you for taking the time to complete this survey.

If you have any questions or comments about this survey or the product to which it pertains, contact info@privateconcepts.com.