Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain

Form Approved

OMB No. 0920-0572

Expiration Date: 03/31/2018

Public reporting burden of this collection of information is estimated as 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-0572).

You are being invited to participate in a research study on behalf of the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control to inform them about clinicians’ practice pertinent to prescription of opioids.

Thank you for participating in this survey. If you agree to take part in this study, you will be asked to complete a consent form and the online survey. The online survey will take you approximately 18 minutes to complete.

You may not directly benefit from this research; however, we hope that your participation in the study may help the CDC to assess its outreach efforts to physicians about this important topic as well as to understand any other informational needs physicians may have. You may also receive customary number of points from the panel provider. 

To the best of our ability, your answers in this study will remain private. By agreeing to participate in this survey, you are allowing the CDC to use the information from this study. The information collected is for research only, and your name will not be shared with anyone outside of this study, except as otherwise required by law. Any results that come from this study will be presented as an aggregate and your name will not be identified with any statements you made.

 

Your participation in this study is completely voluntary and you can stop at any time. You are free to skip any question that you choose. There will not be any penalties if you refuse to participate in this study or refuse to answer any questions. 

If you have questions about this project or if you don’t understand something, you may contact Alec Ulasevich, PhD at ulasevicha@eurekafacts.com or at 240-403-1641.

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