Clinical trial: NCT04314284
Section: Confidentiality
Subsections: How Will You Keep My Information **Confidential?**|Are There **Additional Protections For My Health Information?**

Other people such as those indicated below may become aware of your participation in this study and may inspect and copy records pertaining to this research. Some of these records could contain information that personally identifies you.  
- Government representatives (including the Office for Human Research Protections) to complete federal or state responsibilities
- National Cancer Institute - University representatives to complete University responsibilities
- Washington University's Institutional Review Board (a committee that oversees the conduct of research involving human participants) and Human Research Protection Office. The Institutional Review Board has reviewed and approved this study.  
- Any report or article that we write will not include information that can directly identify you.  
The journals that publish these reports or articles require that we share your information that was collected for this study with others to make sure the results of this study are correct and help develop new ideas for research. Your information will be shared in a way that cannot directly
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APPROVAL DATE: 10/27/20 RELEASED DATE: 10/27/20 EXPIRATION DATE: N/A

Protected Health Information (PHI) is health information that identifies you. PHI is protected by federal law under HIPAA (the Health Insurance Portability and Accountability Act). To take part in this research, you must give the research team permission to use and disclose (share) your PHI for the study as explained in this consent form. The research team will follow state and federal laws and may share your health information with the agencies and people listed under the previous section titled, "How will you keep my information confidential?" Once your health information is shared with someone outside of the research team, it may no longer be protected by HIPAA. The research team will only use and share your information as talked about in this form or as permitted or required by law. When possible, the research team will make sure information cannot be linked to you (de-identified). Once information is de-identified, it may be used and shared for other purposes not discussed in this consent form. If you have questions or concerns about your privacy and the use of your PHI, please contact the University's Privacy Officer at 866-747-4975. Although you will not be allowed to see the study information, you may be given access to your health care records by contacting your health care provider.
Clinical trial: NCT04314284
Section: Possible Risks, Discomforts, and Inconveniences
Subsections: What Are The Risks Of This Study?

You may experience one or more of the risks indicated below from being in this study. In addition to these, there may be other unknown risks, or risks that we did not anticipate, associated with being in this study. One risk of participating in this study is that confidential information about you may be accidentally disclosed. We will use our best efforts to keep the information about you secure. Please see the section in this consent form titled *"How will you keep my information confidential?"* for more information.
Clinical trial: NCT04314284
Section: Procedures
Subsections: What **Will Happen During This Study?**

If you choose to complete in-person:
1. After your next oncology appointment, research staff will schedule a time to meet with you at our office or in the community.  
2. At the appointment, research staff will provide a paper or electronic copy of the survey for you to complete.
We would also like to record the following data from your electronic medical record: insurance status, distress score, and other health conditions. If at any point in the study you no longer wish to participate, you can exit out of the survey. You can send us an email or give us a phone call to let us know you no longer wish to participate. You will not be penalized or lose any benefits for which you otherwise qualify. If you do not tell us you no longer wish to participate in the study or need more time to think about your participation, we will follow-up with you with a phone call and/or email in two weeks. We will reach out three times before removing you from the study.
Clinical trial: NCT04314284
Section: Purpose of Research
Subsections: What Is The Purpose Of This Study?

This is a research study. We invite you to join in this research study because you have been diagnosed with lung, colorectal, or gynecologic cancer in the past. The purpose of this research study is to help cancer patients talk about cancer care costs and use health insurance and other resources to help with some of these costs.
Clinical trial: NCT04314284
Section: Voluntary Participation
Subsections: Is Being In This Study Voluntary?

Taking part in this research study is completely voluntary. You may choose not to take part at all. If you decide to be in this study, you may stop participating at any time. Any data that was collected as part of your participation in the study will remain as part of the study records and cannot be removed. If you decide not to be in this study, or if you stop participating at any time, you won't be penalized or lose any benefits for which you otherwise qualify.
Clinical trial: NCT04314284
Section: Withdrawal from Study
Subsections: If You Decide Not To Sign This Form, It Will Not Affect|What If I Decide To Withdraw From The Study?

- your treatment or the care given by your health provider.  
- your insurance payment or enrollment in any health plans.  
- any benefits to which you are entitled.  
However, it will not be possible for you to take part in the study.

You may withdraw by telling the study team you are no longer interested in participating in the study. If at any point in the study you no longer wish to participate, you can exit out of the survey. You can send us an email or give us a phone call to let us know you no longer wish to participate. You will not be penalized or lose any benefits for which you otherwise qualify.