Consent

1.       Description

This project will assess the following: 1) the frequency and type of depression screening occurring in cardiology practice settings and 2) provider perceptions of the importance of and barriers to screening for depression. The approximately 20-question online survey is to be completed by cardiologists, cardiology fellows, and advanced practice providers who work in a cardiology practice setting. It should take 10-15 minutes to complete. This is a one-time survey and will be hosted online through Survey Monkey. The data from the survey will be collected and analyzed for correlation between variables and with descriptive statistics.  

2.       Risks and Benefits

The information in this survey is anonymous. Individuals who complete the survey will have the option to submit their email address to be entered in a raffle to win one of two $25 gift cards. Participation in the raffle will be strictly voluntary and email addresses will not be correlated with any answers on the survey or entered into the data analysis system, IBM SPSS. This will keep all information anonymous and free from the possibility of being traced back to an individual. This survey will provide insight into current practice and to how to best allocate resources and education to support providers. This survey will discuss patients with depression and suicidal ideation. The sensitive nature of these questions may cause a respondent to feel stressed, anxious, or depressed. I understand that, should I feel uncomfortable in any way, this survey is optional and I may withdraw at any time. I understand that I can choose not to participate in this study due to the potential risks outlined above.

3.       Right to Withdraw

Participation in this research study is completely voluntary. I understand that I am free to refuse to participate in this study or to withdraw anonymously at any time.

4.       Confidentiality/Right to Privacy

The base survey is anonymous and without personal identifiers. I understand that any information collected from the survey will be kept confidential. I understand that I will not be identified in any description or publication of the project. I understand that the composite results of the questionnaire may or may not be used for scientific or scholarly publication purposes; in this event no personally identifiable information will be shared.

I understand that there will be an optional question asking for my email address for the purpose of a gift card raffle (see 5, cost and payment). I understand that entering my email address is strictly voluntary. My email address will not be codified or associated with my survey question responses in any way. I understand that my email address or name will not be part of any scientific or scholarly publication or description of results. Confidentiality statements must be acknowledged by all parties who collect and conduct research.

I understand that I am free to refuse to participate in this study or withdraw at any time.
5.       Cost and Payment

There is no cost or payment for my participation and responses to the questionnaire associated with the this project. I understand that I if I complete the survey, I will have the option to enter my email address into a raffle to win one of two $25 Amazon gift cards. I understand that winners will be chosen at random.

6.       Compensation for Injury or Illness

I understand that in the event of a physical or mental illness resulting from participation in this project, no monetary compensation will be made, and I hereby release Robert Morris University and the investigator from any and all liability. Medical treatment, which may be necessary in the event of physical or mental illness, will be provided at the participant’s expense.

7.       Agreement to Participate

VOLUNTARY CONSENT All of the above has been explained to me and all of my current questions have been answered,. I understand that I am encouraged to ask questions about any aspect of this research during the course of this study and that such future questions will be answered by the researchers listed. Any questions which I have about my rights as a research participant will be answered by the Human Subjects Protection Advocate of the IRB office, Robert Morris University (412-397-6227). By agreeing to these statements, I agree to participate in this research study. I can print a copy of this consent if I wish.

Question Title

* By signing your initials and date below, you agree to the terms of the consent.

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