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RE-MALIK Survey at Mid Study

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Participant Survey at Mid-Study

Thank you from Revive Research Institute, Inc. for being part of the clinical study. To create better experiences for you and other participants in this and future studies, we would like to know about your experiences in the study you are part of now. This survey should take less than 5 minutes to complete.

We will keep your responses anonymous. You do not need to answer all of the questions if you do not want to.

1. First, how satisfied are you with each aspect of the study? Please use a scale of 1 to 5, with 1 meaning that you are “very dissatisfied” and 5 meaning that you are “very satisfied.”

Ease of scheduling study visits*
Wait time for study visits and procedures once I was in the office*
Comfort of waiting area*
Comfort of exam/procedure area(s)*
Private handling of my identity and information*
Parking*
Transportation options*
Payment provided to me*

2. How do you feel about the study visits and procedures?

2a. How often you were required to come in for study visits:*
2b. Number of procedures at each study visit:*
2c. Length of study visits:*
2d. Number of diaries to complete:*
2e. Instructions for how and when to take the study medication(s):*
2f. Were there any procedures that you did not like or found difficult?*

3. Have we understood your needs as a patient in each area of the study? Please rate on a scale of 1 to 5 where 1 means “very poor understanding” and 5 means “excellent understanding.” You can also select “don’t know.”

Goals of the study*
Study procedures*
Study visit schedule*

4. How do you feel about the Study Doctor(s) and Study Coordinator(s) you have been working with during the study, on each of the following? Please use a scale of 1 to 5, where 1 means that you are “very dissatisfied” and 5 means that you are “very satisfied.”

Skill/competence, no errors in my care

skill_competence_study_doctors*
Study Doctor (S)
skill_competence_study_coordinators*
Study Coordinator (S)

Knows a lot about my condition

Knows a lot about my condition study doctors*
Study Doctor (S)
Knows a lot about my condition study coordinators*
Study Coordinator (S)

Understands what it’s like to be somebody with my condition

Understands what it’s like to be somebody with my condition Study Doctors*
Study Doctor (S)
Understands what it’s like to be somebody with my condition Study coordinators*
Study Coordinator (S)

Explains things using words that I understand

Explains things using words that I understand Study Doctors*
Study Doctor (S)
Explains things using words that I understand Study Coordinators*
Study Coordinator (S)

Easy to talk to/Friendly

Easy to talk to/Friendly Study Doctors*
Study Doctor (S)
Easy to talk to/Friendly Study Coordinator*
Study Coordinator (s)

Encouraged questions

Encouraged questions Study Doctors*
Study Doctor (S)
Encouraged questions Study Coordinators*
Study Coordinator (S)

Remembers my personal situation/history

Remembers my personal situation/history Study Doctors*
Study Doctor (S)
Remembers my personal situation/history Study Coordinator*
Study Coordinator (S)

Pays attention to me/not in a rush

Pays attention to me/not in a rush Study Doctors*
Study Doctor (S)
Pays attention to me/not in a rush Study Coordinator*
Study Coordinator (S)

Easy to reach/returns calls

Easy to reach/returns calls Study Doctor (S)*
Study Doctor (S)
Easy to reach/returns calls Study Coordinator (S)*
Study Coordinator (S)

Concerned about my questions and worries/Caring

Concerned about my questions and worries/Caring Study Doctor (S)*
Study Doctor (S)
Concerned about my questions and worries/Caring Study Coordinator (S)*
Study Coordinator (S)

Flexible to meet my needs

Flexible to meet my needs Study Doctor (S)*
Study Doctor (S)
Flexible to meet my needs Study Coordinator (S)*
Study Coordinator (S)

Thoughtful and polite

Thoughtful and polite Study Doctor (S)*
Study Doctor (S)
Thoughtful and polite Study Coordinator (S)*
Study Coordinator (S)

Honest/trustworthy

Honest/trustworthy Study Doctor (S)*
Study Doctor (S)
Honest/trustworthy Study Coordinator (S)*
Study Coordinator (S)

Respectful

Respectful Study Doctor (S)*
Study Doctor (S)
Respectful Study Coordinator (S)*
Study Coordinator (S)

Makes me feel confident about my medical care

Makes me feel confident about my medical care Study Doctor (S)*
Study Doctor (S)
Makes me feel confident about my medical care Study Coordinator (S)*
Study Coordinator (S)

Treats me as a “whole person”

Treats me as a “whole person” Study Doctor (S)*
Study Doctor (S)
Treats me as a “whole person” Study Coordinator (S)*
Study Coordinator (S)

Interested in how my condition affects my life

Interested in how my condition affects my life Study Doctor (S)*
Study Doctor (S)
Interested in how my condition affects my life Study Coordinator (S)*
Study Coordinator (S)
4b. If you were to participate in another clinical trial, which five things about the study staff and site would be most important to you?*
5. Have you experienced any of these during the trial so far? Please select all that apply.*
6. How much has being in the study impacted your daily life so far?*
8. If you are considering dropping out of the trial, can you tell us why? Please check all that apply*
9. Overall, do you feel that you are benefiting from participating in this study?*
10. Based on your experience in this study, how likely would you be to participate in another clinical study in the future? 0=Not at all likely; 10=Extremely likely*
11. How likely would you recommend to others that they participate in a clinical study? 0=Not at all likely; 10=Extremely likely*
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Revive Research Institute, Inc.

28270 Franklin Road
Southfield, MI
48034

T: 248-564-1485
E: info@rev-research.com