Application

Applications are reviewed manually. We will email you within a couple days to notify you of approved process. Please contact CSOC@colemanfoundation.org if you have any questions.

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New User Registration
 
 
 
 
 


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New User Registration
 
 
 
 
 

Where Will The Tool Be Implemented?


Who is Responsible For Overseeing The Use of the Tool?


How Will You Use This Tool?



Research Use


If the Tool will be implemented as part of a research study, please provide a brief summary of the proposed research, and attach a one to two-page summary, including study questions, design, samples, and outcome measures.

Clinical Use


If the CQSC/CSOC Tools will be implemented for clinical use, please provide a brief description of the setting in which it will be used in, the Patient population provided to, and the implementation plan and timetable.

Coleman Supportive Oncology Collaborative User Agreement


Please sign a separate User Agreement for Each Tool.

 

A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed the CQSC/CSOC Tools based on validated instruments (NCCN Guidelines® for Supportive Care and the NCCN Distress Thermometer and Problem List, the PHQ-4, PROMIS, the Commission on Cancer standards (2.4 Palliative Care Services, 3.2 Psychosocial Distress Screening, 3.3 Survivorship Care Plan), ASCO guidance, and the Institute on Medicine’s 2013 Report on Delivering High-Quality Cancer Care.

 

Copyright and Dissemination: The CQSC/CSOC Tools are copyrighted by The Coleman Foundation and  distributed by The Coleman Foundation directly or via their partner The Center for Business Models in Healthcare (Center). Neither tool may be used or modified in any form without prior written permission from The Coleman Foundation.

 

User Fees: At this time, there is no charge for using the Coleman Supportive Oncology Collaborative Survivorship Care Appointment Screening Tool or the Supportive Oncology Screening Tool.

 

User Agreement:  Please read this agreement carefully.  Your signature at the end of this document indicates that you have agreed to comply with the following:

 

Public Distribution of the CQSC/CSOC Tools:  Do not distribute the CQSC/CSOC Tools to anyone outside of your institutional group, division, or department, or place it on a public website without first obtaining The Coleman Foundation’s prior written permission, which may be withheld at The Coleman Foundation’ sole discretion.

 

Use of the CQSC/CSOC Tools:  For clinical use, the CQSC/CSOC Tools are available in pen/paper formats at this time.  You may not convert the Tools to any other online or web-based administration without prior permission from The Coleman Foundation.

 

Quarterly Reports:  Within thirty days of the end of a calendar quarter, you must provide The Center for Business Models in Healthcare with aggregate, non-identifying information on the number of patients screened using the CQSC/CSOC Tools, and answer some basic questions (see example on page 4).  You must submit this information in a timely manner, as it is required by our funding source in exchange for the institutional use of the CQSC/CSOC Tools, which is free of charge.  The Center will send you a reminder each quarter with a link to the survey.

 

Research use of the CQSC/CSOC Tools If you plan to use the CQSC/CSOC Tools for research, you must obtain any required institutional approvals prior to use. Please provide The Coleman Foundation with a brief written summary of your current or proposed research, highlighting the study questions, design, sample, and outcome measures. In addition to the quarterly report, you shall provide The Coleman Foundation/The Center with a brief final report at the end of your project, summarizing your study outcomes and data, including any papers, posters or manuscripts that reported on your use of the CQSC/CSOC Tools.

 

 

Clinical use of the CQSC/CSOC Tools:  If you plan to use the CQSC/CSOC Tools clinically, you must obtain any required institutional approvals prior to use.  In addition, please provide The Coleman Foundation with a brief description of your setting and the patient population.

 

Contact Information: Indicate the name and full contact information for the person responsible for overseeing / supervising the use of the CQSC at your institution.  Please provide updated contact information in the event of personnel changes.

 

Scientific Publications / Presentations:  While we encourage publication and dissemination of your results from using the CQSC/CSOC Tools, if you plan to publish or present information or data regarding your use of the CQSC/CSOC Tools, please provide an abstract or manuscript at least thirty days in advance of submission or presentation.  We will send you a specific language and reference you must include when describing the CQSC/CSOC Tools in your manuscript.

 

After receiving and reviewing your completed application form, The Coleman Foundation (or via their partner The Center for Business Models) will communicate with you about any questions and provide permission to use the CQSC/CSOC Tools.  The Center will send you your official copy of the CQSC/CSOC Tools to use.

 

Additional Information:

 

Updates on the CQSC/CSOC Tools: The Coleman Foundation will communicate and collaborate with CQSC and CSOC users on a regular basis regarding implementation and evaluation. The Coleman Foundation will provide you updated information on the CQSC/CSOC Tools as it becomes available.

 

Changes to the CQSC/CSOC Tools:  The CQSC/CSOC Tools are copyrighted measures.  You may not modify or change either of the CQSC/CSOC Tools in any way without prior written permission from The Coleman Foundation.

 

Other Terms and Conditions

 

  1. Warranty Disclaimer. You will accept the CQSC/CSOC Tools “as-Is.”  THE COLEMAN FOUNDATION makes no representations or warrantees, express or implied, WITH respect to the CQSC/CSOC Tools or any adaptations or translations derived therefrom.  by way of example but not limitation, The Coleman Foundation makes no representations of commercial utility, mercantability, or fitness for any particular purpose, or that the use of the CQSC/CSOC Tools will not infringe any rights of any third party.  The Coleman Foundation shall not be held to any liability with respect to any claim FROM a third party on account of, or arising from, the use of the CQSC/CSOC Tools.

 

  1. To the extent permissible by law, Recipient Institution agrees to defend, indemnify, and hold harmless The Coleman Foundation and their partner’s organizations for all claims, liabilities, and costs (including reasonable attorneys’ fees) arising from the use of the CQSC/CSOC Tools.  The terms of this Section 2 shall survive the termination of this Agreement.

 

  1. Term and Termination. This agreement will remain in force for three years from the signing date below.  Either party may terminate this agreement for any reason upon thirty days written notice to the other party.  Upon termination, the Recipient Institution will cease use of the CQSC/CSOC Tools and send to The Coleman Foundation any outstanding reports.

 

  1. These terms and conditions shall survive termination of this Agreement.

 

Note: you may use a digital signature, or type your name in lieu of a digital signature.

If you have any questions, please contact: csoc@colemanfoundation.org ; One of our team members will follow up promptly after receipt of this form.

*Required field

Applications are reviewed manually. We will email you within a couple days to notify you of approved process. Please contact CSOC@colemanfoundation.org if you have any questions.

No time now? Request Emailed Link

Please enter your email address below and we will send you a link to the Supportive Oncology Collaborative Tools access Application to fill out later.

Please wait...
to fill out this form later.