Clinical trial: NCT04448678
Section: Confidentiality
Subsections: Authorization For Use Of Your Protected Health Information|How We Will Protect And Share Your Information:

Signing this document means you allow us, the researchers in this study, and others working with us to use some information about your health for this research study.  
This is the information we will use and include in our research records:  
- Demographic and identifying information like name, current age, gender, insurance information, address, telephone number, and email address.  
- Related medical information about you like personal and family medical history, primary diagnosis, age at diagnosis, current and past medications or therapies.

- We will do everything we can to keep your information private but we cannot guarantee this. Study information will be kept in a secured manner and electronic records will be password protected. Study information may be stored with other information in your medical record. Other doctors, nurses, and third parties (like insurance companies) may be able to see this information as part of the regular treatment, payment, and health care operations of the hospital. We may also need to disclose information if required by law.  
- In order to conduct this study and make sure it is conducted as described in this form, the research records may be used and reviewed by others who are working with us on this research:  
| University of Utah                                         |
|------------------------------------------------------------|
| Institutional Review Board Exemption 3/2/2020 IRB_00127029 |  
  
o Members of the research team at University of Utah, Huntsman Cancer Institute, Intermountain Health Care o The University of Utah Institutional Review Board (IRB), who reviews research involving people to make sure the study protects your rights;
- If we share your information with groups outside of University of Utah Health or Intermountain Healthcare we will not share your name or identifying information. We will label your information with a code number, so they will not know your identity.  
- If you do not want us to use information about your health, you should not be part of this research.  
If you choose not to participate, you can still receive health care services at University of Utah Health and Intermountain Healthcare.
Clinical trial: NCT04448678
Section: Possible Risks, Discomforts, and Inconveniences
Subsections: Risks

There are some small risks related to taking part in this study. Questions and discussion about health insurance can be psychologically stressful. As a reminder, you may choose not to answer or discuss any questions that you do not want to and may decide to drop out of the study at any time. There is also a small risk of loss of confidentiality, but we do everything possible to keep your information secure.
Clinical trial: NCT04448678
Section: Procedures
Subsections: Study Procedures

If you decide to join this study, you will be randomly assigned to Group A or **Group B**. You will be asked to take part in the study for about 5 months, which will span the study activities of the initial survey, the completion of the program, and a post-program survey. You may also be asked to complete an interview after these activities have been completed with a member of the study team.  
Both **Group A** participants and **Group B** participants will participate in surveys.  
- The surveys will be given at two different times - at study enrollment and again about 2 months after that for a follow-up.  
- We will ask you to answer a set of questions about your medical history, basic demographic information, and your insurance experiences, knowledge, and coverage history.  
- Answering these questions should take no more than approximately 15 minutes each time. You do not have to answer any questions that make you uncomfortable.  
| University of Utah                                         |
|------------------------------------------------------------|
| Institutional Review Board Exemption 3/2/2020 IRB_00127029 |  
  
If you are assigned to **Group A**, the following things will happen:
- Insurance Education Sessions (videoconferencing-based options available): The study team will arrange 4 health insurance educational sessions between you and a patient navigator that will occur every other week over 2 months. The sessions will be 30 minutes long and can be delivered to you inperson, over the phone or through an online videoconference portal. If needed, this will allow you to take part in the sessions on a device of your choosing (smartphone, tablet, laptop, desktop computer, etc.) You may opt out of the sessions at any time.  
- Mailing of a Health Insurance Information Booklet: The study will also send you a mailed copy of "The Healthcare Law: How it Can Help People with Cancer and Their Families", a booklet developed by the American Cancer Society.
- Exit Interview (videoconferencing-based options available): The study will contact you to schedule an interview upon your completion of the health insurance education sessions. This one time interview will be conducted by a study team member, and will be occur in-person, over the phone or through an online videoconference portal. If needed, this will allow you to take part in the sessions on a device of your choosing (smartphone, tablet, laptop, desktop computer, etc.) Interviews are estimated to be about 20 minutes long.  
If you are assigned to **Group B**, the following things will happen:  
- You will be able utilize the standard patient navigation services as usual.  
- Mailing of a Health Insurance Information Booklet: The study will send you a mailed copy of "The Healthcare Law: How it Can Help People with Cancer and Their Families", a booklet developed by the American Cancer Society.
Clinical trial: NCT04448678
Section: Voluntary Participation
Subsections: Voluntary Participation

Research studies include only people who choose to take part. You can tell us that you don't want to be in this study. You can start the study and then choose to stop the study later. This will not affect your relationship with the investigator or anyone on your healthcare team.
Clinical trial: NCT04448678
Section: Withdrawal from Study
Subsections: What If I Decide To Not Participate After I Sign The Consent And Authorization **Form?**

You can tell us anytime that you do not want to be in this study and do not want us to use your health information. You can also tell us in writing. If you change your mind, we will not be able to collect new information about you, and you will be withdrawn from the research study. However, we can continue to use information we have already started to use in our research, as needed to maintain the integrity of the research.  
This authorization does not have an expiration date.