Appendix 4
OhioHealth
Columbus, OH
Survey Cover Letter
Title of Study: Breast Cancer Risk Assessment in the General Population at the Time of Screening Mammography: Patient Perceptions and Clinical Management Outcomes
Principal Investigator: Nichole Morman, MS, LGC
You had a screening mammogram performed at OhioHealth between September 2013 and May 2014 and opted to have a free personalized breast cancer risk assessment performed. The average woman’s risk for breast cancer is 10-12% and the purpose of the assessment was to determine if your risk for breast cancer is greater than the average woman’s risk. As a result of the assessment, you received a letter in the mail stating your breast cancer risk and recommendations. Your physician will have received a copy of this letter as well and may or may not have discussed these recommendations with you.
As a result of your participation in the breast cancer risk assessment, you are being asked to take part in a research project on your perception of breast cancer risk and your breast healthcare plans. The project is being conducted by Nichole Morman, MS, LGC from the OhioHealth Genetic Counseling Program. The research will help us understand if offering a free breast cancer risk assessment to all women at the time of their screening mammography is beneficial to a woman’s breast healthcare and results in compliance with recommendations.
All you need to do is complete this short 9-question survey, which should take approximately 5-10 minutes. Your participation is voluntary. If you do not wish to take part, simply discard the survey. You can refuse to answer questions that you do not wish to answer. You can decide to withdraw from the study at any time without penalty or repercussion.
Responses will be kept confidential and your name will not appear anywhere on the survey. Completing and returning the survey confirms your consent to take part.
Keep this letter for your records. If you have any questions regarding the research, contact the OhioHealth Genetic Counseling Program at 614-566-4363 and ask to speak with a Genetic Counselor. If you have any questions regarding your rights as a research subject, please contact the OhioHealth IRB #1 at (614) 566-4739 to speak with Dr. Borgess. This office oversees the review of the research to protect your rights and is not involved with this study.
Thank you again for your help.
Version Date: 09/08/2014Page 1 of 1