CENTERS OF EXCELLENCE IN CANCER COMMUNICATIONS RESEARCH Release Date: March 21, 2002 RFA: CA-03-007 (Reissued as RFA-CA-08-004) National Cancer Institute (NCI) (http://www.nci.nih.gov/) LETTER OF INTENT RECEIPT DATE: July 18, 2002 APPLICATION RECEIPT DATE: August 15, 2002 This RFA is a reissue of RFA-CA-01-019, which was published in the NIH Guide on February 5, 2001. THIS RFA CONTAINS THE FOLLOWING INFORMATION o Purpose of this RFA o Research Objectives o Mechanism of Support o Funds Available o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Special Requirements o Where to Send Inquiries o Letter of Intent o Submitting an Application o Peer Review Process o Review Criteria o Receipt and Review Schedule o Award Criteria o Required Federal Citations PURPOSE This initiative is the centerpiece of the National Cancer Institute's (NCI) Extraordinary Opportunity in Cancer Communications. The purpose of the extraordinary opportunities is to identify areas of discovery that build upon important recent developments in knowledge and technology and that hold promise for making significant progress against all cancers. The novelty and scope of this initiative reflects the enormous potential of cancer communication to improve health and the NCI's recognition that effective communications can and should be used to narrow the enormous gap between discovery and the application of discoveries and to reduce health disparities among our citizens. The primary focus of the centers should be the advancement of cancer communication science through the generation of new knowledge rather than mere replication or minor modification of previous studies and theories. The RFA uses the P50 centers mechanism to invite applications for Centers of Excellence in Cancer Communications Research (CECCRs). The Centers must include three or more individual hypothesis-driven research projects, plus a pilot or developmental research project process, cores and a plan for career development. To be effective, the Centers' research should integrate cancer communications appropriately into one or more contexts of the cancer continuum--from prevention through treatment to survivorship and end-of-life research. Communications research also is needed about challenging topics such as cancer information seeking, decision making under uncertainty, and genetic testing. Centers' research should provide insight into mechanisms underlying how cancer information is generated, accessed, attended to and/or processed. It is expected that the Centers' interdisciplinary efforts will result in new and/or improved syntheses, theories, methods and interventions, including those for diverse populations. The centers will provide essential infrastructure to facilitate rapid advances in knowledge about cancer communications, translate theory and programs into practice, and train health communication scientists. In essence, the Centers should catalyze major advances in cancer communication rather than "tinker" with well-developed hypotheses and interventions. Potential applicants are encouraged to consult the NCI's Bypass Budget (http://plan2003.cancer.gov and http://2001.cancer.gov/) for background about the NCI's goals and progress in cancer communications. RESEARCH OBJECTIVES Background Healthy People 2010 defines health communication as the research-based crafting and delivery of messages and strategies to promote the health of individuals and communities (http://www.health.gov/healthypeople/). Communication is central to quality cancer care, from primary prevention to survivorship (Institute of Medicine (IOM), 1999). http://www.nap.edu/books/0309064805/html/. There is a substantial literature that shows communication interventions can raise awareness of health problems and recommended actions, give people the information they need to make informed cancer-related decisions and motivate action (e.g., Skinner et al., 1999; O'Connor et al., 1999; Science Panel on Interactive Communication and Health, 1999). The framers of the National Cancer Act of 1971 (and the subsequent amendments to that Act) were acutely aware of the central importance of cancer communication. Thus, they mandated that the NCI provide a program to disseminate scientific and other information regarding the causes, prevention, detection and treatment of cancer. Pursuant to this mandate, and mindful of the dramatic changes in the technologies of both health care and information, the NCI has dramatically expanded its commitment to cancer communications to ensure that all Americans have access to the cancer information they need and are able to use it effectively. As articulated in the Fiscal Year 2001, 2002 and 2003 NCI bypass budgets, The Nation's Investment in Cancer Research, the Institute is committed to improve knowledge about, tools for, access to, and use of high quality, evidence-based cancer communications regardless of race, ethnicity, health status, education, income, age, gender, culture, or geographic region. Health communication research is a vibrant field concerned with the powerful roles performed by human and mediated communication (Kreps, Bonaguro, & Query, 1998). A wide range of scientists and communicators have been studying the process of effective communication and its impact on health for more than 25 years, and much has been learned. There are increasingly refined theories of information processing, health communication and health behavior, including those that focus on how people represent and process health information, respond to cancer-related risks and change cancer-related behaviors. Intervention research on effective health communications has contributed to increasing proportions of Americans eating at least five fruits and vegetables per day, obtaining breast and cervical cancer screening, as well as to declining rates of smoking among many groups. Changes in the role and accessibility of information are altering health care practices, patient-practitioner relationships and the way consumers and patients acquire and use information (Eng, et al., 1998; 1999; Patrick, 1999). Activated, empowered patients and direct-to-consumer advertising are changing the nature of practitioner-patient communications, and there is an opportunity to examine the impact of these altered relationships. Home computer and Internet use are on the rise, with a recent survey reporting that almost 72 percent of Americans had gone online in 2001 compared to about 67 percent in 2000 (UCLA Internet Report 2001). Approximately sixty million people searched for on-line health information in 2000, and cancer information was one of the most sought-after topics (Pew Internet, 2000; Cyber Dialogue, 2000). Both consumers and professionals have, or will have, a host of new opportunities for creating, distributing and acquiring health information from the World Wide Web, individually-tailored print and multimedia materials, interactive computer games, interactive kiosks, wireless devices, and many other channels and sources. But empirical evidence is critically needed about the efficacy and effectiveness of health communications interventions using these modalities. Data especially are needed about how these strategies can be used to meet the needs of diverse populations. A number of groups and reports, including most recently, the National Survey of Attitudes About Clinical Trials (The Cancer Letter, October 13, 2000), have emphasized the need for major new communication efforts about cancer clinical trials. With the rapid pace of discovery in the basic and clinical sciences, the aging of the U.S. population, the increasing population of cancer survivors, and the growing number of households in which someone is a caregiver for a person with cancer, the need and demand for high quality cancer information will continue to grow. Patients are increasingly being asked to make decisions about health care choices, such as whether to get a prostate specific antigen (PSA) test or what treatment to choose for breast or prostate cancer (e.g., Entwistle et al., 1998), and these decisions must be informed by effective communication. A significant proportion of patients are not satisfied with the communication component of their health care interactions, and want more information than they receive (e.g., Thorne, 1999). The development of effective interventions and tools for informed decision making should use the wealth of available evidence from fields such as education, instructional design, cognitive psychology, and human factors research. There is an evidence base that shows what can be achieved through decision aids, e.g., changes in knowledge and some other intermediate outcomes. More research is needed in these areas to develop interventions that can be extended beyond clinical settings as well as to additional, especially diverse, populations. The Science Panel on Interactive Communications and Health (Eng, 1999) concluded that few other health-related interventions have the potential of interactive health communications to simultaneously improve health outcomes, decrease health care costs and enhance consumer satisfaction. New information technologies, such as the Internet and World Wide Web, combine the attributes of both mass and interpersonal communication (Strecher, 1999). Yet, they should not replace older but effective strategies including mass media, one- on-one counseling, and tailored print communication. Existing and new technologies should be integrated based on scientific knowledge to provide a menu of choices. http://www.health.gov/scipich/pubs/finalreport.htm. The increasing complexity of every element of cancer communications, from the understanding of cancer itself, to the rapid evolution of new media and the recognition of the manifold needs of diverse audiences, demands a broadly interdisciplinary approach. Bringing people together from different disciplines can accelerate the speed with which discoveries are made, translated into researchable hypotheses and interventions and then developed into products that benefit people. A recent IOM report, Bridging Disciplines in the Brain, Behavioral and Clinical Sciences, stressed that "solutions to existing and future health problems will likely require drawing on a variety of disciplines and on approaches in which interdisciplinary efforts characterize not only the cutting edge of research, but also the utilization of knowledge" (IOM, 2000, p.2). Cancer communications will not be understood in a vacuum. Progress can be accelerated if clinicians work, for example, with psychologists, advocates, communication experts and patients to learn the best ways to engage patients in decision making or to talk about participation in clinical trials. Molecular biologists could collaborate with epidemiologists, psychologists, journalists, genetic counselors, communication scientists, philosophers, computer scientists, high risk persons and others to determine how to communicate about genetic mutations that predispose to cancer risks. Mathematicians, decision scientists, and medical anthropologists might be engaged in research on cancer risk communication. In addition, research teams would benefit from people who understand how to communicate and market in compelling, engaging ways in order to transcend the deluge of competing media. The challenges of cancer communications will not be surmounted if disciplines work in isolation. (Applicants should note that these disciplines are provided as illustrative and are not prescriptive. The team needed for any project depends on the problem.) A significant increase in the size of the cancer communications research enterprise is needed to develop the next generation of research and interventions. At the same time, the enterprise must be informed by a greater scientific understanding of the mechanisms by which these communications work and a commitment to diffusion. The result should be both knowledge and practical strategies to enhance cancer communications and improve the control of cancer. Objectives and Scope In accordance with the National Cancer Institute's Extraordinary Opportunity in Cancer Communications (see http://cancercontrol.cancer.gov/eocc), the NCI invites grant applications for Centers of Excellence in Cancer Communications Research (CECCR). CECCRs are expected to conduct research that will lead to major scientific advances in knowledge about cancer communications and their translation into practice. There are several over-arching goals. o Increase the number of investigators from relevant disciplines who focus on the study of cancer communications as part of interdisciplinary teams. o Generate basic research evidence to improve understanding of the processes underlying effective cancer communication. o Support novel interdisciplinary research to inform medical and public health practitioners about how best to communicate to the public, patients, and cancer survivors. o Produce evidence-based communication interventions that can be used to modify cancer risk behaviors and improve informed decision-making and quality of life. o Increase the number of evidence-based interventions in under-studied areas, e.g., diagnosis, treatment, survivorship and end-of-life, and on understudied populations. o Train interdisciplinary investigators capable of conducting cutting-edge communications research directly relevant to the context of cancer prevention, detection, treatment, control, or survivorship. o Increase the number of peer-reviewed publications in the area of cancer communication systems and processes. The focus can include, but is not limited to, cancer risk communication, evidence-based interventions to enhance cancer communication, communication methods for diverse and under-served populations, innovative communication strategies to increase informed decision making and participation in clinical trials, communication about genetic testing, survivorship and palliative care/end of life issues, as well as communication interventions to improve cancer prevention and early detection behaviors. We also invite research to elucidate the psychological mechanisms underlying the cancer communication process, understand how people use cancer information, test innovative strategies to overcome the digital divide in access to cancer-related information, examine media coverage of cancer and factors that influence the generation of mediated information, and develop and evaluate methods to enhance the dissemination of evidence-based cancer communication interventions. Researchers are encouraged to examine the ethical issues associated with cancer communications as well as the cost-effectiveness of evidence-based interventions. Centers can conduct basic, intervention and dissemination research in a variety of settings, including laboratories, clinical and community settings. They do not have to cover all aspects of the cancer continuum; focus is expected. However, there should be a focus on translatability – from basic to intervention research to dissemination and sometimes back again (Hiatt and Rimer, 1999). In all this, the essential focus of the Centers is expected to be in the development and/or major improvement in our understanding of the science of cancer communications. Where possible, evidence-based research products should be put quickly into the public domain through Web-based access using open source tools. CECCRs investigators will be encouraged to share tools not only among themselves but also with the larger community. Software and other tools, such as Common Gateway Interface (CGI) scripts and interactive data-gathering tools, should be thoroughly documented for purposes of replication and dissemination. Investigators must provide evidence that they have a mechanism in place by which to disseminate evidence-based products and interventions that emerge from this research. Reliance on or production of proprietary technologies that would inhibit dissemination and replication is discouraged. Applicants are encouraged to collaborate with other organizations. These may include any of the following, but the Centers are not required to do so nor are they limited to them: NCI-designated Comprehensive Cancer Centers, Cancer Information Service, Special Populations Networks, and other NCI-funded research projects, such as the Cancer Family Registries, Cancer Genetics Networks, Transdisciplinary Tobacco Use Research Centers (TTURCs) and the Specialized Programs of Research Excellence (SPOREs) as well as the Centers for Disease Control and Prevention, the American Cancer Society and other voluntary health associations, the Robert Wood Johnson Foundation, National Science Foundation grantees, and industry. In addition, collaborations should be considered with universities, including Schools of Public Health, Historically Black Colleges and Universities, public health agencies, community technology centers and other organizations. The active participation of advocacy groups and appropriate community organizations is encouraged. Relevant collaborations with NIH intramural programs can be included as well. FOCUS OF CENTERS Overview Investigators should represent a broad range of disciplines working together to increase knowledge about cancer communications. Some centers might be virtual centers or collaboratories where the expertise is drawn from multiple locations. Originally coined by the National Science Foundation by combining "collaboration" and "laboratory," collaboratories are secure, user- configurable, virtual project spaces. Geared towards fostering inter- organizational teamwork, they contain rich tools and services for research and development projects that span organizations, geographic regions, and time zones. Studies can focus on one-to-one communication, interpersonal methods, such as small groups, mass media, print and electronic communications, new media or combinations thereof. Since communication strategies do not exist in a vacuum, it is likely that applications that focus on only one communications strategy will be less competitive. To answer some questions, it may be appropriate to generate preliminary data via laboratory-based research and smaller-scale studies which permit highly controlled manipulation of the components of interventions before launching large-scale field trials crucial for determining effectiveness. The level of specialization in different aspects of cancer communications research will vary from center to center, e.g., topics, points on the cancer continuum, populations, levels of analysis and types of research. However, the centers should focus thematically on areas in which there are significant gaps in knowledge and critical needs--where focused, collective, interdisciplinary efforts could make a difference. It is incumbent upon investigators to articulate the gap areas. It is expected that the CECCRs will catalyze problem solving and lead to more rapid advances in knowledge than would be possible by depending on individual investigators working in relative isolation. CECCRs should contribute to understanding what works and what does not work and why. In most cases, the studies will require a recognition of the cognitive, psychological, and sociocultural influences on health behaviors. The "sine qua non" of the Centers consists of at least 3 research projects with an integrative theme, cores and plans for career development and use of developmental funds. Investigators are encouraged to include theory-based projects that bridge basic and intervention research. Potential Research Topics Note that these are examples only and will not constitute evaluation criteria. Elucidate Basic Mechanisms in Cancer Communications o Answer questions about the psychosocial mechanisms by which cancer messages exert their impact, including mediators of cancer risk communication. o Clarify how people seek, process and use health information and develop a greater understanding of how cognitive and emotional factors affect processing (Croyle, Sun, and Hart, 1997). Explain the Communication Process o Increase understanding of how people search for, use and respond to cancer information within the complex and changing information environment and how this is affected by individual and structural factors such as age, access, ethnicity, income, community, culture and personality. Improve Decision Making o Improve understanding of how patients process complex information about the benefits and risks of different medical options and make decisions in the face of considerable uncertainty (Croyle and Lerman, 1999). o Examine the impact of interventions to improve cancer-related decision making and the impact of activated patients upon practitioner-patient communication and family communication. Improve Risk Communication o A number of important topics in risk communication research were identified as high priorities by experts who attended an NCI-sponsored meeting on cancer risk communication (December 1998). The papers from the meeting were published in a September, 1999 monograph supplement to the Journal of the National Cancer Institute and include many potential topics. Improve Communication for Diverse Audiences o Promote knowledge about, access to and use of cancer information for low literacy and other diverse audiences as well as children and adolescents affected by cancer. Design More Effective Interventions o Conduct research that contributes to an effective menu of communication choices for different audiences, including traditional communication methods, such as mass media, one-on-one and small group education strategies, print and telephone communication strategies; proactive strategies, such as telephone counseling and tailored print communications; and interactive technologies, such as the Internet, kiosks and CD-ROMs. What is the optimal mix of communication strategies? How do presentation and format interact to affect message impact? How can interventions be combined to maximize their impact? What are the fundamental mechanisms that lead to differential outcomes when using a "media mix"? That is, the focus should go beyond simply comparing different modalities and/or audiences to an understanding of WHY different interventions or previously tested interventions in different audiences matter. o Conduct research on the relative contribution to improved outcomes of varying amounts of message intensity, complexity, and burden on receivers, and development costs. Evaluate stepped-care approaches to communications. o Outcomes include not only knowledge and behaviors but also health care costs, health care utilization, and quality-adjusted life years saved. o Examine the impact of integrated communications systems that include multiple channels of communication, including interpersonal, intrapersonal, mass media and new media to give people the information they want, how they want it, when and where they want it. Use of the New Media o Wired for Health http://www.health.gov/scipich/pubs/finalreport.htm and the recent IOM report Networking for Health (http://www.nap.edu/catalog/9750.html) make a number of suggestions for research on the new media. Applicants interested in new media research are encouraged to consult these sources. Interventions should go beyond mere use of new technologies to advance the understanding of communication and health behavior processes within the new media context. Improve Interpersonal Communication o Examine the role of interpersonal, including practitioner-patient communication and group communication in promoting informed decision making, psychosocial adjustment, personal adaptation, and social support for individuals confronting cancer. Improve Media Coverage o How does media treatment of issues influence the cancer-related understanding and behavior of different publics? How might one improve and influence the media treatment of cancer to promote public understanding of cancer prevention and treatment (Finnegan & Viswanath, 1997)? Understand and Improve Diffusion of Best Practices o Identify the fundamental mechanisms that enhance dissemination to populations in contrast to the basic mechanisms underlying individual change over time (Abrams et al., 1999). Restrictions on Applications The NCI now funds many studies that compare tailored print interventions to usual care interventions or "kitchen sink" interventions to usual care. However, when these studies have not been successful in achieving significant impact, it usually has not been possible to identify the reasons. Research funded under this initiative should not be limited to studies that focus only on outcomes. Rather, the studies should represent a major advance in terms of innovation, theory testing, intervention strategy and methodology. A major emphasis should be to understand what works, what does not work and why, in order to identify generalizable principles and processes of communication. Research exclusively focused on health professionals is not appropriate. Proposals that are exclusively focused on outreach or service delivery also are not acceptable. Nor are proposals that merely apply theories in a general way to the design of interventions acceptable. Instead, the design of the proposed research is expected to meaningfully use theories and to test and/or improve upon them. Applicants should clearly indicate how theoretical constructs are to be used and measured. There is no a priori assumption that one theory is better than another. However, adequate justification is required for the selection of one or more particular theories. MECHANISM OF SUPPORT This RFA will use the NIH P50 award mechanism. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project. Support of this program will be through the specialized center (P50) grant mechanism. Although this RFA uses a P50 mechanism, it is not a SPORE. This mechanism supports the full range of research and development from basic to clinical and intervention studies. The spectrum of activities comprises a multidisciplinary approach on a specific disease entity or biomedical problem. These grants differ from traditional program project grants in that they are more complex and flexible in terms of the activities that can be supported. In addition to support for interdisciplinary research projects, support is also provided for pilot research projects, specialized resources, career development programs, and shared core facilities. Applicants will be responsible for the planning, direction, and execution of the proposed CECCR program. Awards will be administered under NIH grants policy as stated in the NIH Grants Policy Statement. The total project period for applications submitted in response to the present RFA may not exceed 5 years. The earliest anticipated award date is July 1, 2003. Because the nature and scope of the research proposed in response to this RFA may vary, it is anticipated that the size of awards will also vary. FUNDS AVAILABLE The NCI intends to commit approximately $10 million in FY 2003 to fund 4 to 5 new grants in response to this RFA assuming sufficient numbers of very high quality applications. An applicant may request a project period of up to 5 years and a budget for direct costs of up to $1,500,000 per year, excluding Facility and Administrative costs on consortium arrangements. Because the nature and scope of the research proposed might vary, it is anticipated that the size of each award will also vary. Although the financial plans of the National Cancer Institute include support for this program, awards pursuant to the RFA are contingent upon the availability of funds and the receipt of a sufficient number of meritorious applications. There is no guarantee that there will be subsequent reissuances of this RFA. ELIGIBLE INSTITUTIONS You may submit (an) application(s) if your institution has any of the following characteristics: o For-profit or non-profit organizations o Public or private institutions, such as universities, colleges, hospitals, and laboratories o Units of State and local governments o Eligible agencies of the Federal government o Domestic or foreign o Faith-based organizations o Domestic applications with foreign components are permitted To be considered, applicant organizations must have: (1) an established investigator as a Principal Investigator (PI) who can oversee and conduct planning activities, provide direction to the CECCR, ensure an interdisciplinary research emphasis, and build a career development program; and (2) full institutional commitment from the applicant institution. Clearly delineated and formally confirmed subcontracted, collaborative scientific arrangements with scientists from other institutions, including foreign institutions, may be included. INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH programs. SPECIAL REQUIREMENTS The Centers must include three or more individual research projects, which reflect hypothesis-driven research, plus pilot or developmental research projects, shared resources (cores) and career development. Centers must provide clear evidence of an interdisciplinary focus, including an explanation of how the projects fit together across disciplines to promote synergy and syntheses. Evidence of plans and mechanisms for dissemination of research findings and products, including evidence-based tools and interventions must be stated. Interactions among CECCRs are an important part of this initiative. Centers must identify creative strategies to foster formal and informal intra- and inter-center collaborations to identify and address overarching scientific and methodological issues. This may be in the form of research collaborations, participation in Web-based communication exchanges by scientists on a visiting basis, exchange of data, resources and materials, and other mechanisms. A requirement for all CECCR Principal Investigators and selected project investigators is participation in two meetings per year in the Washington, DC metropolitan area or other mutually convenient location. At least three project staff should be budgeted per meeting. Support for this travel should be included in the budget. The purpose of these meetings is to share scientific information, assess scientific progress, solve problems, identify new research opportunities, and establish priorities that will accelerate the translation of basic research findings to applied settings in patients and populations. Novel opportunities to facilitate collaboration also will be developed. The NCI is currently engaged in efforts to understand the function and effectiveness of large funding initiatives such as CECCRs. Centers are expected to work with NCI staff in these efforts. The aim of this requirement is not to influence the research objectives and evaluation of individual CECCRs or other grants but to understand the processes of communication and collaboration among the Centers and how those processes contribute to the achievement of the goals of the CECCRs initiative. Centers must include certification that meets the new requirement for education in human subject protections. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html CECCR Program Requirements The following information must be provided in the application: o A minimum of three fully developed R01-type research projects; o Evidence of an interdisciplinary focus, including an explanation of how the projects fit together across disciplines to promote synergy and syntheses; o Shared administrative, technical, statistical, and other resources that can be justified; o Applications are strongly discouraged from naming individual members of "advisory committees" or "scientific boards" until the time the application has been funded; o The CECCR must demonstrate a consistent and significant commitment to a career development program in cancer communication research. This may focus on graduate students, post-doctoral candidates, junior faculty, or established investigators who wish to develop or refocus their careers on cancer communication research. The description of this program should include the policies, criteria, and processes for selecting candidates, including special efforts to recruit qualified women and minorities. The plan should include the number and types of positions that will be made available, the criteria for eligibility and selection of candidates, and a description of the selection process. The plan should not include stipends and trainee costs though salary support for career development candidates may be requested; o A proposed process for funding developmental and pilot research to facilitate new collaborations and support the exploration of new ideas and methods. The interest here is in the process of solicitation and selection of the pilot projects rather than on the pilot projects itself. It is important that CECCRs use pilot funds to stimulate projects that take maximum advantage of new research opportunities. Such projects may be collaborative among scientists within one or more CECCRs, or with scientists outside the CECCR environment. The CECCR application should propose and describe an institutional review process that selects pilot projects for center funding that represent the most innovative and interdisciplinary ideas. Applicants may supply a short description (2 pages maximum per project) of up to two eligible projects as examples. The NCI is especially interested in opportunities to engage arts and sciences university faculties and schools of public health in collaboration with medical schools and/or cancer center faculty; o Creative strategies to foster formal and informal intra- and inter-center collaborations to identify and address overarching conceptual and methodological issues; o Evidence of plans and mechanisms for the dissemination of research findings and products, including evidence-based tools and interventions; o Certification that meets the new requirement for education in human subject protections. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00- 039.html All clinical trials supported or performed by NCI require some form of monitoring. The method and degree of monitoring should be commensurate with the degree of risk involved in participation and the size and complexity of the clinical trial. Monitoring exists on a continuum from monitoring by the principal investigator/project manager or NCI program staff to a Data and Safety Monitoring Board (DSMB). These monitoring activities are distinct from the requirement for study review and approval by an Institutional Review Board (IRB). For details about the Policy of the NCI for Data Safety & Monitoring of Clinical Trials see http://deainfo.nci.nih.gov/grantspolicies/datasafety.htm WHERE TO SEND INQUIRIES We encourage inquiries concerning this RFA and welcome the opportunity to answer questions from potential applicants. Inquiries may fall into three areas: scientific/research, peer review, and financial or grants management issues: Direct inquiries regarding scientific/research issues to: K. "Vish" Viswanath, Ph.D. Health Communication and Informatics Research Branch Behavioral Research Program Division of Cancer Control and Population Sciences National Cancer Institute 6130 Executive Blvd, MSC 7363, EPN Room 4070 Bethesda, MD 20892-7363 [Rockville, MD 20852 - express mail] Telephone: (301) 594-6644 FAX: (301) 480-2087 Email: firstname.lastname@example.org Direct your questions about peer review issues to: Referral Officer National Cancer Institute Division of Extramural Activities 6116 Executive Boulevard, Room 8041, MSC 8329 Bethesda, MD 20892-8329 Telephone: (301) 496-3428 FAX: (301) 402-0275 Email: email@example.com Direct your questions about financial or grants management matters to: Ms. Crystal Wolfrey Grants Administration Branch National Cancer Institute 6120 Executive Boulevard, Suite 243 Bethesda, MD 20892-7340 Rockville, MD 20852 (for express/courier service) Telephone: (301) 496-8634 E-mail: firstname.lastname@example.org LETTER OF INTENT Prospective applicants are asked to submit a letter of intent that includes the following information: o Descriptive title of the proposed research o Name, address, and telephone number of the Principal Investigator o Names of other key personnel o Participating institutions o Number and title of this RFA Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information allows NCI staff to estimate the potential review workload and plan the review. The letter of intent is to be sent to Dr. Viswanath by July 18, 2002: K. "Vish" Viswanath, Ph.D. Health Communication and Informatics Research Branch Behavioral Research Program Division of Cancer Control and Population Sciences National Cancer Institute 6130 Executive Blvd, MSC 7363, EPN Room 4070 Bethesda, MD 20892-7363 [Rockville, MD 20852 - express mail] Telephone: (301) 594-6644 FAX: (301) 480-2087 Email: email@example.com SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 435-0714, Email: GrantsInfo@nih.gov. PRE-APPLICATION MEETING The NCI will hold a pre-application meeting through a teleconference to which all interested prospective applicants are invited. Program staff & staff from the Division of Extramural Activities (DEA) will make presentations that explain their goals and objectives for the Centers for Excellence in Cancer Communication Research and answer questions from the attendees. Prospective applicants are urged to monitor the NIH Guide Notice for the date and time of the meeting at http://grants.nih.gov/grants/guide/index.html. SUPPLEMENTAL INSTRUCTIONS: Additional instructions for preparing a CECCR grant application are available from the program staff listed under INQUIRIES and can also be found at the following URL link: http://dccps.nci.nih.gov/communicationcenters/ The instructions must be requested and used in preparing a CECCR application. USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) application form must be affixed to the bottom of the face page of the application. Type the RFA number on the label. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box must be marked. The RFA label is also available at: http://grants.nih.gov/grants/funding/phs398/label-bk.pdf. SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the Checklist, and three signed, photocopies, in one package to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 Bethesda, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must be sent to: Referral Officer Division of Extramural Activities National Cancer Institute 6116 Executive Blvd., Room 8041, MSC-8329 Rockville, MD 20852 (express courier) Bethesda MD 20892-8329 APPLICATIONS HAND-DELIVERED BY INDIVIDUALS TO THE NATIONAL CANCER INSTITUTE WILL NO LONGER BE ACCEPTED. This policy does not apply to courier deliveries (i.e. FEDEX, UPS, DHL, etc.) (http://grants.nih.gov/grants/guide/notice- files/NOT-CA-02-002.html) This change in practice is effective immediately. This policy is similar to and consistent with the policy for applications addressed to Centers for Scientific Review as published in the NIH Guide Notice http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-012.html. APPLICATION PROCESSING: Applications must be received by the application receipt date listed in the heading of this RFA. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an Introduction addressing the previous critique. PEER REVIEW PROCESS Upon receipt, applications will be reviewed for completeness by the CSR and for responsiveness by the NCI program staff. Incomplete applications will be returned to the applicant without further consideration. And, if the application is not responsive to the RFA, CSR staff may contact the applicant to determine whether to return the application to the applicant or submit it for review in competition with unsolicited applications at the next appropriate NIH review cycle. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the Division of Extramural Activities (DEA) at NCI in accordance with the review criteria stated below. As part of the initial merit review, all applications will: o Receive a written critique o Undergo a selection process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed and assigned a priority score o Those that receive a priority score will undergo a second level review by the National Cancer Advisory Board. REVIEW CRITERIA The criteria to be used in the evaluation of grant applications are listed below. The application must represent more than an interesting collection of projects. It is critical that there be evidence of the potential for a meaningful center with a real theme and identity. The Centers must include three or more individual research projects, which reflect hypothesis-driven research, plus a process for pilot or developmental research projects, shared resources (cores) and career development. The Center and the projects should result in the generation of new knowledge in cancer communication processes and science. Reviewers will evaluate each research project using the criteria listed below. Each criterion will be addressed and considered by the reviewers in assigning the overall score for project merit: A. RESEARCH PROJECTS: a.1. Significance. The importance of the research objective to human cancer communication and its likelihood of completion within the project period. a.2. Approach. The adequacy of the experimental design and methods to achieve the research objectives. Are the theoretical framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative interdisciplinary approaches? a.3. Innovation. Originality and novelty of the experimental design as it relates to cancer communication theory and research. Does the project develop new methodologies or technologies in cancer communication? Does the research design reflect sufficient originality, novelty, and innovation to make it highly relevant to the overall goals and objectives of the CECCR? a.4. Investigators. The qualifications of investigators to conduct the proposed research and the appropriateness of the time commitments of each member of the team to the conduct of the project. Are the investigators appropriately qualified with demonstrated competence to conduct the proposed research? Is the proposed work appropriate to the experience level of the Principal Investigator and project researchers? Are the proposed time commitments for all key laboratory and clinical researchers reasonable and adequately associated with the project? a.5. Environment. The scientific environment in which the research work will be done, and the unique features, if any, of the environment to support the proposed work. Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed projects take advantage of unique and interdisciplinary features in the scientific environment and reach out to useful collaborative arrangements? Is there evidence of adequate institutional support? Is the project interactive with other components of the CECCR, conceptually, experimentally, and translationally? a.6. Interdisciplinary Collaboration. Is there evidence of significant interdisciplinary basic, clinical and public health interactions in the conception, design, and proposed implementation of the project? Is the proposed research informed by the breadth of relevant scientific literature from multiple disciplines in the social, behavioral, and biological sciences? The initial review group will also examine: the appropriateness of proposed project budget and duration; the adequacy of plans to include both genders and minorities and their subgroups, and children as appropriate for the scientific goals of the research and plans for the recruitment and retention of subjects; the provisions for the protection of human and animal subjects; and the safety of the research environment. B. SHARED RESOURCES (CORES) b.1. adequacy of the justification for each specialized resource relative to its essential need for the conduct of CECCR research or pilot projects and CECCR collaborative projects. b.2. adequacy of qualifications and performance (if applicable) of managers of resources to conduct high quality, reliable resource operations. b.3. appropriateness of the requested budgets to conduct each resource operation. b.4. adequacy of plans for oversight of resources and the prioritization of work C. CAREER DEVELOPMENT c.1. adequacy of the process and/or track record for selecting candidates for career development who demonstrate potential for independent research careers in interdisciplinary cancer communication-related research or who are established investigators and are changing the direction of their research careers; cross-disciplinary training should enable scientists to bridge scientific domains in health communication research, to foster important integrative scientific inquiry; c.2. adequacy of the procedures and/or track record to seek out and include qualified minorities, women, and persons with disabilities in the career development program; c.3. adequacy of the individuals available in the program to serve as possible mentors of career development candidates; the current availability and adequacy of projects for career development candidates; c.4. appropriateness of the budget relative to the proposed plans for sustaining a significant activity in career development. Stipends and trainee costs are not allowable. However, salary support for career development candidates may be included; c.5. complementary activities that contribute to the environment for career development; c.6. capacity of the overall program to absorb career development candidates and prepare them for independent interdisciplinary cancer communication- related research careers. D. DEVELOPMENTAL RESEARCH PROGRAM (PILOT PROJECTS) d.1. adequacy of the process and/or track record for attracting new ideas for pilot studies within the CECCR. d.2. adequacy of the proposed process and/or track record for continuously reviewing and funding a spectrum of pilot projects (e.g., research, technology development, resources) for their quality, innovativeness, interdisciplinary nature and importance to translational research that will have an impact on enhancing cancer communication efforts and developing innovative new cancer communication programs. d.3. general quality of the pilot projects described in the application to demonstrate the effectiveness of the process for selecting pilot projects funding; d.4. appropriateness of the budget relative to the needs and demonstrated capabilities of the CECCR and potential of the program to generate innovative pilot projects on a consistent basis; d.5. degree to which developmental funds will be used to stimulate pilot projects with interdisciplinary interactions and/or collaborative interactions with other scientists within or outside of the parent institution, and especially with other NCI-funded centers and programs; E. OVERALL PROGRAM ORGANIZATION AND CAPABILITY e.1. scientific qualifications and involvement of the Principal Investigator, as well as his/her demonstrated scientific and administrative leadership capabilities; adequacy of the time commitment of the Principal Investigator; e.2. interdisciplinary nature of the proposed research activities, integration of the projects around an overarching theme, and plans to effectively pursue interdisciplinary research objectives; e.3. adequacy of access to patients and populations for conducting current and projected research; e.4. adequacy of the procedures, processes, and plans for promoting interdisciplinary interactions, including coordination, interaction, collaboration and synthesis; e.5. facilitation of technology transfer; management of the intellectual property rights of the CECCR under the requirements of the Bayh-Dole Act and NIH funding agreements; e.6. written assurance that CECCR interactions with commercial entities will uphold the principles of academic freedom, including the ability of CECCR investigators to collaborate freely, and to send and receive research materials without restriction to other scientific researchers; e.7. evidence of full protection of human subjects for clinical research components, and appropriate mechanisms for the rigorous management and verification of research data; e.8. plans for the recruitment and retention of research subjects and patients and adequacy of those plans to include both genders, minorities and their subgroups, and children as appropriate to meet the scientific goals of the research; e.9. adequacy of plans for dissemination of evidence-based interventions. e.10 adequacy of plans to promote and maintain communication and integration of scientific projects of mutual interest with other CECCRs; e. 11. willingness to interact with other CECCRs and with the NCI in sharing information, in assessing scientific progress, in identifying new research opportunities and in establishing scientific priorities. F. INSTITUTIONAL COMMITMENT f.1. Adequacy of facilities, equipment and space to promote interdisciplinary and translational research objectives; f.2. Adequacy of institutional procedures and plans for monitoring, evaluating, and assuming accountability for the general success of the CECCR; f.3. Adequacy of the institutional infrastructure for assessing progress and needs. ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application will also be reviewed with respect to the following: o PROTECTIONS: The adequacy of the proposed protection for humans, animals, or the environment, to the extent they may be adversely affected by the project proposed in the application. o INCLUSION: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children (under 21) as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria included in the section on Federal Citations, below) o DATA SHARING: The adequacy of the proposed plan to share data. o BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. OVERALL EVALUATION AND SCORING OF APPLICATIONS A single numerical priority score will be assigned to the CECCR application as a whole after discussing all of the review elements listed above. The score will be based on the overall quality of the research projects, the career development program and the developmental research program, the overall effectiveness and adequacy of shared resources, the overall program organization and capability, and the plans for interactions with other CECCRs. Although primary emphasis will be placed on scientific merit, significant consideration will also be given to interdisciplinary interactions, potential for impacting on the disease, inter-Center collaborations and institutional commitment. RECEIPT AND REVIEW SCHEDULE Letter of Intent Receipt Date: July 18, 2002 Application Receipt Date: August 15, 2002 Peer Review Date: January/February 2002 Council Review: May 2003 Earliest Anticipated Start Date: July 1, 2003 AWARD CRITERIA Award criteria that will be used to make award decisions include: o Scientific merit (as determined by peer review) o Availability of funds o Programmatic priorities. REQUIRED FEDERAL CITATIONS MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components involving Phase I and II clinical trials must include provisions for assessment of patient eligibility and status, rigorous data management, quality assurance, and auditing procedures. In addition, it is NIH policy that all clinical trials require data and safety monitoring, with the method and degree of monitoring being commensurate with the risks (NIH Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html). Clinical trials supported or performed by NCI require special considerations. The method and degree of monitoring should be commensurate with the degree of risk involved in participation and the size and complexity of the clinical trial. Monitoring exists on a continuum from monitoring by the principal investigator/project manager or NCI program staff or a Data and Safety Monitoring Board (DSMB). These monitoring activities are distinct from the requirement for study review and approval by an Institutional review Board (IRB). For details about the Policy for the NCI for Data and Safety Monitoring of Clinical trials see: http://deainfo.nci.nih.gov/grantspolicies/datasafety.htm. For Phase I and II clinical trials, investigators must submit a general description of the data and safety monitoring plan as part of the research application. See NIH Guide Notice on "Further Guidance on a Data and Safety Monitoring for Phase I and II Trials" for additional information: http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-038.html. Information concerning essential elements of data safety monitoring plans for clinical trials funded by the NCI is available: http://www.cancer.gov/clinical_trials/ INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported clinical research projects unless a clear and compelling justification is provided indicating that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing clinical research should read the AMENDMENT "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research - Amended, October, 2001," published in the NIH Guide for Grants and Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice- files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.ht m. The amended policy incorporates: the use of an NIH definition of clinical research; updated racial and ethnic categories in compliance with the new OMB standards; clarification of language governing NIH-defined Phase III clinical trials consistent with the new PHS Form 398; and updated roles and responsibilities of NIH staff and the extramural community. The policy continues to require for all NIH-defined Phase III clinical trials that: a) all applications or proposals and/or protocols must provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) investigators must report annual accrual and progress in conducting analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: The NIH maintains a policy that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at http://grants.nih.gov/grants/funding/children/children.htm. REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. A continuing education program in the protection of human participants in research in now available online at: http://cme.nci.nih.gov/ HUMAN EMBRYONIC STEM CELLS (hESC): Criteria for federal funding of research on hESCs can be found at http://grants.nih.gov/grants/stem_cells.htm and at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html. Only research using hESC lines that are registered in the NIH Human Embryonic Stem Cell Registry will be eligible for Federal funding (see http://escr.nih.gov). It is the responsibility of the applicant to provide the official NIH identifier(s)for the hESC line(s)to be used in the proposed research. Applications that do not provide this information will be returned without review. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. Applicants may wish to place data collected under this RFA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This RFA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/ AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance No. 93.399 and 93.393. Awards are made under authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and administered under NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. REFERENCES Abrams DB, Mills S, Bulger D. Challenges and future directions for tailored communication research. Annals of Behavioral Medicine 1999;21(4):299-306. Cancer Risk Communication: What we know and what we need to learn. Journal of the National Cancer Institute. Monographs, 1999;25:1-185. Croyle, RT, Lerman, C. Risk communication in genetic testing for cancer susceptibility. Journal of the National Cancer Institute Monographs, 1999;25:59-66. Croyle, RT, Sun, Y, Hart, M. Processing risk factor information: Defensive biases in health-related judgments and memory. In K. Petrie & J. Weinman (Eds.), Perceptions of Health and Illness: Current Research and Applications. London: Harwood Academic Publishers; 1997. p. 267-290. Cyber Dialogue. (October 27, 2000). Internet health seekers reach critical mass. Cyber Dialogue Re:Sources. http://www.cyberdialogue.com/news/index.html. Department of Health Human Services (DHHS) Healthy People 2010 (Conference Edition, in Two Volumes). Washington, DC: January 2000. Eng TR, Maxfield A, Patrick K, Deering MJ, Ratzan SC, Gustafson DH. Access to health information and support: A public highway or a private road? Journal of American Medical Association, 1998;280(15):1371-5. Eng TR, Gustafson DH, Henderson J, Jimison H, Patrick K. Introduction to evaluation of interactive health communication and applications. American Journal of Preventive Medicine 1999;16(1):10-15. Entwistle VA, Sheldon TA, Sowden A, Watt IS. Evidence-informed patient choice: Practical issues of innovating patients in decisions about health care technologies. International Journal of Technology Assessment in Health Care 1998; 14(2):212-225. Finnegan, J. R. & Viswanath, K.. Communication Theory and Health Behavior Change. In K. Glanz, F. M. Lewis & B. K. Rimer (Eds.), Health Behavior and Health Education: Theory, Research and Practice (2nd Edition), San Francisco, CA: Jossey-Bass Inc., Publishers; 1997: p. 313-341. Fiore, MC, Bailey, WC, Cohen, SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health. June 2000. Hornik, R. Public health education and communication as policy instruments for bringing about changes in behavior. In M.E. Goldberg, M. Fishman (ed); et al. Social Marketing: Theoretical and practical perspectives. Advertising and consumer psychology. Mahwah, NJ, U.S.: Lawrence Erlbaum Associates, Inc; 1997. p. 45-48. Institute of Medicine and National Research Council Report: Ensuring Quality Cancer Care. Washington, D.C: National Academy Press; 1999. Institute of Medicine: Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences. Washington, D.C: National Academy Press; 2000. Kreps GL, Bonaguro EW, Query JL Jr. The history and development of the field of health communication. In L.D. Jackson and B.K. Duffy (eds.), Health Communication Research. Westport, CT: Greenwood Press; 1998. p. 1-15. Lerman C, Hughes C, Croyle RT, Main D, Durham C, Snyder C, Bonney A, Lynch JF, Narod SA, Lynch HT. Prophylactic surgery decisions and surveillance practices one year following BRCA 1 / 2 testing. Preventive Medicine 2000;31:75-80. Miller TE, Reents S. The health care industry in transition: The online mandate to change. Cyber Dialogue for Intel Corporation; 1998. O'Connor AM, Fiset V, DeGrasse C, Graham ID, Evans W, Stacey D, et al. Decision-aids for patients considering options affecting cancer outcomes: Evidence of efficacy and policy implications. Journal of the National Cancer Institute Monographs 1999;25:67–80. Park, DC, Morrell, RW (ed), et al. Processing of medical information in aging patients: Cognitive and human factors perspectives. Mahwah, NJ, USA: Lawrence Erlbaum Associates, Inc.; 1999. p. 199-219. Patrick K. Prevention, public health, and interactive health communication. American Journal of Preventive Medicine 1999;16(1):46-47. Pew Internet Project. More online, doing more: 16 million newcomers gain Internet access in the last half of 2000 as women, minorities and families with modest incomes continue to surge online. February 2001. http://www.pewinternet.org/pdfs/PIP_Changing_Population.pdf. Roter, DL, Hall, JA. Doctors talking with patients/patients talking with doctors: Improving communication in medical visits. Westport, CT, USA: Auburn House/Greenwood Publishing Group, Inc.; 1992. Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO. How effective is tailored print communication? Annals of Behavioral Medicine 1999;21(4):290- 298. Strecher, VJ, Greenwood, T, Wang, C, Dumont, D. Interactive multimedia and risk communication. Monograph National Cancer Inst 1999;25:134-139. Thorne, SE. Communication in cancer care: What science can and cannot teach us. Cancer Nursing 1999;22(5):370-378. Science Panel on Interactive Communication and Health. Wired for health and well being: The emergence of interactive health communication. Office of Disease Prevention and Health Promotion. U.S. Department of Health and Human Services. Washington, D.C.; 1999. UCLA Center for Communication Policy. The UCLA Internet Report 2001 -- Surveying the Digital Future. Los Angeles: University of California; 2001. Whaley, BB (ed) et al. Explaining illness: Research, theory, and strategies. LEA's Communication Series. Mahwah, NJ, U.S.: Lawrence Erlbaum Associates, Inc.; 2000. p. 171-194.
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