Introduction and Agreement of Participation

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You are being invited to participate in a research study titled “Putting Yourself in your Patient's Shoes: A Pilot Study of Physician Personal Preferences for Treatment of Glioblastoma”. This study is being done by Dr. Clark C. Chen and Dr. Bob S. Carter from the University of California - San Diego (U.C.S.D.).

If you agree to take part in this study, you will be asked to complete a 10 question online survey that will take about 5 minutes. Questions are in multiple-choice format, but include optional free-text boxes wherein you can elect to write down thoughts or comments about each question. Any question can be skipped; however for the sake of our analysis we ask you to answer all questions if at all possible.

We are interested in the various factors that may alter your decisions regarding Glioblastoma therapy when deciding FROM THE PERSPECTIVE OF A HYPOTHETICAL PATIENT. As a result, we have included some questions which are considered personal, but none are identifiable.

We believe there are no known risks associated with this research study; however, as with any online related activity the risk of a breach of confidentiality is always possible. To the best of our ability your answers in this study will remain confidential. We will minimize any risks to breach of confidentiality by not collecting personal identifying information as part of this survey study. You will be asked only about basic background demographic and professional information. The data generated by your survey responses will be stored securely in a remote database at the University of California, San Diego and will be analyzed in the aggregate. Research records will be kept confidential to the extent allowed by law and may be reviewed by the UCSD Institutional Review Board.

SurveyMonkey may use "cookies" as part of its software. These cookies will not be used to gather personal identifying information. SurveyMonkey adheres to the Safe Harbor Principles of notice choice, onward transfer, security, data integrity, access and enforcement. You may view the SurveyMonkey certificate of adherence at https://safeharbor.export.gov/list.aspx.

Your participation in this study is completely voluntary and you can withdraw at any time by simply closing the survey window, or by clicking "Exit this survey" at the top right of your screen. If you choose to withdraw from the survey none of your answers will be collected or stored.

You may not directly benefit from this research, but you may find it helpful to work through the clinical scenarios from a personal standpoint. From a societal perspective, we anticipate that a greater understanding of physician preferences with respect to treatment decisions will ultimately help patients tasked with making a decision of their own in this context.

If you have questions about this project or if you have a research-related problem, you may contact the researcher, Dr. Clark Chen at 619-534-5540. If you have any questions concerning your rights as a research subject, you may contact the UCSD Human Research Protections Program Office at (858) 657-5100.

By clicking “Next” below you are indicating that you are at least 18 years old, have read this consent form and agree to participate in this research study.

We thank you for your time and participation.
      Clark Chen, MD PhD - Principal Investigator, U.C. San Diego Department of Neurosurgery
      Colin Depp, PhD - Co-Investigator, U.C. San Diego Department of Psychiatry
      Bob Carter, MD, PhD - Co-Investigator, U.C. San Diego Department of Neurosurgery
      Bayard Wilson, BA - Sub-Investigator, U.C. San Diego School of Medicine
      U.C.S.D. Institutional review board protocol #151821 - status exempt

You agree to participate (click "Next")

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