Consent to Participate in a Research Study

Jodi R. Lee, Principal Investigator

Project Title: The Influence of Palliative Care on Savings for Hospitals:
A Qualitative Descriptive Study

Hello, my name is Jodi R. Lee and you are invited to take part in a research study. I am a
graduate student in the Doctor of Business Administration Program at Franklin University in Commented [DL1]: Per the IRB website online
Columbus, Ohio. As part of the requirements for earning my doctorate, I am doing a research anonymous survey template- Use this type of CONSENT
FORM for research projects that involve:
project.
−Anonymous Surveys completed online
Why is this study being done?
The purpose of my project is to study the influence of palliative care on savings for hospitals −Research participants who are ADULTS (age 18 and
older).
based on the experience of healthcare administrators. You received an invitation to participate
because you are a healthcare director, medical director, or administrator in Pulmonary or −For online survey research, a consent handout may be
Cardiology and care for patients with COPD and CHF. COPD and CHF patients may receive administered by various electronic methods including in
palliative care due to their condition. an email to potential participants, a separate web page,
cover, or first page of the survey, etc.

What am I being asked to do? The consent link will be included on the research flyer
If you participate in this project, you will be asked to fill out an anonymous online survey. The followed by the survey link.
survey contains screening questions, demographic questions about your role, health system, and
Palliative Care program. The final questions ask about the participants experience with
Palliative Care and any associated cost savings. Commented [DL2]: Added clarification to the types of
roles and added medical director.

Taking part in this study is your choice.

Your participation in this project is completely voluntary. You may stop participating at any time. Commented [DL3]: Previously approved language-
placed in new template.
If you stop being in the study, there will be no penalty or loss of benefits you would normally
have. Commented [DL4]: Previously approved language
placed in new template and changed from interview to
anonymous survey.
What will happen if I decide to take part in this study?
The survey consists of 28 questions and the survey will take approximately 45 minutes or less to
complete based on length of responses. During the interview, you will be asked questions like, Commented [DL5]: Language changed to reflect the
"Explain the difference between Palliative Care and Hospice regarding goals/services or change from interview to survey.
benefits?" and "Does the hospital-based or community Palliative Care service attend census,
rounds, team, or service line meetings?"
What are the risks and benefits of taking part in this study?
I believe there is little risk to you for participating in this research project. You may become
stressed or uncomfortable answering any of the survey questions. If you do become stressed or
uncomfortable, you can skip the question by marking “N/A” if applicable, or take a break. You
can also stop taking the survey or you can withdraw from the project altogether. Commented [DL6]: Previously approved language and
added “N/A”.
There will be no direct benefit to you for participating in this survey. The results of this project
may assist other healthcare professionals in learning more about palliative care and potential cost
savings. Cost savings information may result in additional support for palliative care programs in
hospitals.

Confidentiality and Privacy:

Surveys are anonymous. The researcher will not collect any information to identify you as a
participant. All participants will be assigned a two-digit number to protect their identity.
Participants are not to share what hospital or health system where you work. Information Commented [DL7]: Previously approved language.
gathered from the survey will be combined into themes. Any electronic files will be kept solely Added survey. Added information about combining study
results into themes.
on a jump drive(s) and on a computer used only by the researcher for the duration of the study.
The researcher will retain paper records and jump drive(s) in a locked box that only the
researcher will have access to. All materials will be kept for three years after the study is
concluded, after which all materials will be shredded or burned. The researcher will maintain a
copy of the data for any future empirical articles written. Commented [AW8]: Are you keeping paper records? If
not, remove the language regarding the binder, paper
records, shredding/burning records….
Only my Franklin University dissertation chair and I will have access to the information. Other
agencies that have legal permission have the right to review research records. The Franklin Commented [JL9R8]: Yes, I will keep paper as well.
University IRB has the right to review research records for this study. Commented [DL10]: Previously approved language.

Compensation:
There will be no compensation for your time and effort in participating in this research project. Commented [DL11]: Previously approved language.

Questions:
If you have any questions about this study, please email me at leej26@email.franklin.edu . You
may also contact my dissertation chair, Dr. Timothy Reymann, at tim.reymann@franklin.edu Dr.
Beverly Smith at beverly.smith@franklin.edu. If you have any questions regarding your rights as Commented [DL12]: Changed Study Chair name and
a research participant, please contact the Franklin University IRB Office at 614-947-6037 or added email.
irb@franklin.edu.
Commented [DL13]: Previously approved language.
Added change in Committee Chair.
To Access the Survey: Please click the button link below to proceed and participate in this study.
By clicking on the survey below, it is assumed that you are consenting to participation in the Commented [DL14]: Added Link on the bottom of the
consent document to allow participants to go directly into
study. If you do not wish to participate, please close out your browser window. the survey form.
Commented [DL15]: The consent and survey links are
Survey Link: Click below if you would like to participate in included in the social media text-see example.

the study. Commented [DL16]: IRB template language.

Commented [DL17]: Added the phrase about clicking
http://forms.office.com/r/eRctURz08i on the link and assuming consenting to the study as
discussed-IRB on 5/26/23.