Healthcare Professionals Survey

* 1. INFORMED CONSENT
INTRODUCTION: You are being asked to participate in a research project entitled Hospice Residence Facility Feasibility in St. Lawrence County which is being conducted by the Clarkson University Honors Program, with principle investigator, Jennifer Ball, Ph.D. This survey is confidential. The study will most likely result in publication of information provided in the surveys. However, all information that could identify individual participants will be removed.
PURPOSE: Hospice and Palliative Care of St. Lawrence Valley (Hospice SLV) is evaluating the feasibility of establishing a hospice community residence, designed to accommodate those for whom in-home care is impractical.
The purpose of this study is to gain professional insight regarding the feasibility and design of a hospice residence facility.
CONFIDENTIALITY: The survey is confidential. All responses will be returned to the principal investigator and not Hospice PCSLV. The information gathered will be securely retained the principal investigator. In addition, the investigator has signed a HIPPA Business Associate Agreement with Hospice PCSLV. Please make sure to close browsers and a secure computer for the survey in order to minimize security risks.
COSTS and COMPENSATION: There is no charge to you for being in this study. You will also not receive any payment for being in this study. Your information will not be sold.
RISKS: Risks associated with the study are slight and limited to temporary emotional discomfort. Although you may find some of the questions briefly upsetting, there are no anticipated long-term risks to you related to your participation in this study. If any questions asked at any time during this survey cause you to remember personally traumatic or emotional experiences, and you feel the need to talk to a trained professional about these memories, you may wish to contact, the counseling center at Hospice PCSLV of Saint Lawrence Valley by phone at (315) 265-3105.

STOPPING THE STUDY: Your participation in this survey is voluntary. You can choose to refrain from answering any particular question at your discretion. You may choose at any time to end your participation in the group or refuse to participate in the study without penalty or loss of benefits to which you are otherwise entitled.
IRB REVIEW: This study has been approved by Clarskon University’s Institutional Review Board (IRB) review in accordance with Federal regulations. The IRB, a university committee established by Federal law, is responsible for protecting the rights and welfare of research participants. If you have concerns or questions about your rights as a research participant, you may contact Dr. Johndan Johnson-Eilola, Associate Chair of the Clarkson University Institutional Review Board (IRB) for human subjects research at (315)268-6488 or Johndan@clarkson.edu
QUESTIONS: Questions regarding the purpose or procedures of the research should be directed to the principal investigator Jennifer Ball, who may reached by phone at (315) 268-4208 or by email jball@clarkson.edu.
CONSENT: By participating in this survey and checking below, you certify that you are at least 18 years of age and you authorize Hospice SLV as well as Clarkson University to utilize the responses collected as part of the aforementioned research.