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A Multidisciplinary Approach to the Treatment of Pediatric Patients with Cystic Fibrosis: Scheduling Patients’ Treatments and Daily Activities Arkansas Children’s Hospital Consent Form You and your child are being asked to participate in a research study being conducted with patients with cystic fibrosis at Arkansas Children’s Hospital. The purpose of this study is to find out if putting patients on a daily activity schedule will increase compliance with medical treatments and other aspects of care. The study will also evaluate whether following a daily activity schedule helps patients and families better prepare for treatments, medications, therapy, or other activities because they know what to expect next. The benefits of this study include: 1) the provision of consistency in expectations for patients families, and staff allowing them to know what to expect next and what is expected of them, which may help to increase patient compliance with treatments and therapy; 2) providing some control for the patient while hospitalized, as the patient will participate in the creation of the daily activity schedule, with some activities being negotiable between patient and staff; and 3) the use of a schedule may also help the staff in their ability to work with the patients in the study without scheduling conflicts with other staff members. There are no foreseeable risks involved in participating in this research study. This study will involve patients with cystic fibrosis who are between the ages of 8 and 16. The number of participants will vary depending on the number of eligible patients admitted to the hospital during the study period. Confidentiality of you as the respondent and your responses will be protected throughout the course of the study and publication, with the one exception being that your responses and records may be reviewed by the University of Arkansas for Medical Sciences Human Research Advisory Committee. Your participation in this research study is completely voluntary and you can decline to participate at any time. Following parental or legal guardian consent, your participation and assent in this study remains voluntary and you can refrain from answering any or all questions without penalty or explanation. You can, at any time during your enrollment in the study, withdraw your participation without penalty or affecting the care that you receive while a patient at Arkansas Children’s Hospital. Any significant new findings that are developed during the course of the study that may relate to your willingness to continue participating in the study will be provided to you. In addition, your participation in the study may be terminated at the discretion of the investigator without your consent. If you decline to participate in the study, you will receive the same standard of care at Arkansas Children’s Hospital as study participants, without the formal scheduling of daily activities. The length of your participation in the study will depend on the length of your hospital stay. Your initial participation will involve completing a 5-question incomplete story task, where you and your parent will, individually, be asked to complete the story in your own words. A voice recording will be made of your answers to this task. You will then be asked to work with the investigator to develop a daily activity schedule, which you will follow throughout your hospital stay. There will be no activity added to this schedule that you would not already be expected to do during your hospitalization. At the conclusion of your hospital stay, you and your parent will be asked to complete a short survey about your participation in the study. There will be no monetary or other compensation for participation in this research study. By signing this form you, in no way, waive any legal rights to which you are already entitled. You and/or your parents will not incur any additional costs for treatment at Arkansas Children’s Hospital related to your participation in this research study. If you have any questions or comments concerning this research study the primary investigator, Nikki Orkoskey, can be reached 24 hours a day by paging 0729 on the Arkansas Children’s Hospital paging system. If you have any questions about your rights as a research subject, you can call the Human Research Advisory Committee representative at phone number (501) 6865667. This study was also approved by the University of Akron Institutional Review Board for the Protection of Human Subjects. Questions or comments can also be directed to Dr. Gerry Parker, Director, at the University of Akron Institutional Review Board by phone at (330) 9726764 or by mail at Office of Research Services and Sponsored Programs, The University of Akron, Akron, OH 44325-2102. I have read the above statement and have been able to ask questions and express concerns, which have been satisfactorily responded to by the investigator. I understand the purpose of the study as well as the potential benefits and risks that are involved. I hereby give my informed and free consent to be a participant in this study. I have been given a copy of this consent form. I (We) consent to this study and allow my (our) child’s participation: Parent or Legal Guardian Principal Investigator Date Date Parent or Legal Guardian Date Witness Date I understand what I am being asked to do by agreeing to participate in this research study and I understand that because my parent/legal guardian signed the form above does not mean I have to participate in this study. I understand that by signing the form below I am agreeing to participate in this research study. Assent provided via my signature: Participant Date