Behavioral consent form template -- annotated

 

Leave box empty - For office use only

Annotations:

Blue is for subject-pool specific items

Red are general comments for everyone

Green marks OPRS notes that should be deleted

 

Behavioral Research Consent form template - 12/17/99

Instructions for BEHAVIORAL RESEARCH template:

1.     Add running footer of :

Short Study title or Number Version #, [date]Page # of # Real title, not the cryptic name for postig

2.     Text already typed usually stays.

3.     Text in [ ] gives directions and some options.

4.     Suggested text is underlined

5.     à and italics indicate guidelines.

 

Excuse the run-on words, abrupt type-size changes and other idiocies; I made the stupid mistake of setting this up in Microsoft WORD, the least workable program ever written.

                                                                                             

                                      University of Illinois at Chicago

                                  Consent for Participation in Research

                                              “Title of Research”

This should be the “real” title, not the cryptic name used for posting in the sign-up area

Why am I being asked?  Headings do make this easier to read…

You are being asked to be a subject in a research study about [add a brief description of the study] conducted by[add name of investigator or student/faculty; investigator’s department and/or college] at the University of Illinois at Chicago and [insert names of any other cooperating institutions]. Don’t be slavish! Some of these read as if the problem being investigated were caused by the investigator (“…study of illegal drug trafficking conducted by Dr….” You have been asked to participate in the research because [explain how subject was identified] and may be eligible to participate. You don’t have to tell subject pool people they are in the subject pool! Drop “and may be eligible…” We ask that you read this form and ask any questions you may have before agreeing to be in the research.

Your participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relations with the University or [insert the names of any other cooperating institutions as well]. If you decide to participate, you are free to withdraw at any time without affecting that relationship. 

 

Why is this research being done?

[Using lay language, include a short summary of the research purpose, procedures involved, the risks, benefits, and alternatives, if any.]

The heading and the instructions don’t agree! The research is not being done because of the risks and alternatives. You have 3 options:

  1. If your study is complex, and involves several sessions, an outline like what is in the instructions is a good idea. But change the heading to “Summary”, and keep this box around it to set it apart from all the other headings, which are in question form.
  2. If there is a general reason for the research and this is a specific part of it, it would be reasonable to reply to the question in the headline. Then this answer (box optional) tells the overall reason (“X is a major problem and no data tell us how to deal with it”) while the next section (Purpose) says what this experiment will do to answer a part of it (“will test whether Y changes behavior, ameliorates, etc”).
  3. Rather than simply fill space with a redundant answer, simply eliminate this box and heading.

What is the purpose of this research?

The purpose of this research is: (this may supercede the previous box) Do NOT repeat the preceding as both a subheading and your first sentence!

[Explain research question and purpose in lay language.]

 

What procedures are involved?

If you agree to be in this research, we would ask you to do the following things:

à Describe the procedures chronologically using simple language, short sentences and short paragraphs. The use of subheadings helps to organize this section and increases readability. Medical and scientific terms should be defined and explained. Identify any procedures that are experimental.

à Specify the subject's assignment to study groups, length of time for participation in each procedure, the total length of time for participation, frequency of procedures, location of the procedures to be done, etc.

à If there are calendars, flowcharts, tables or pictures, that would help explain the procedures, note what they are and attach them.

Approximately [add number of subjects] may be involved in this research at the University of Illinois at Chicago. [If a multicenter research add the total number of subjects anticipated and projected number of research sites.] It is often better to put this paragraph at the beginning, so it doesn’t sound like you are asking the subjects to recruit N people. 

 

What are the potential risks and discomforts?

The research has several risks: 

[Explain the risks, discomforts and inconveniences including the likelihood, severity, and reversibility, if applicable, of each risk.] Don’t repeat the first sentence. Many people say “The research has several risks: There are several risks to the research:” 

àIf there are significant physical or psychological risks to participation, the subject should be told under what conditions the researcher would stop the research itself or stop the subject’s participation in the research.

à If there is a potential for a subject to be participating in more than one research protocol at the same time, add a statement that the subjects should inform the researcher if they are currently participating in a research protocolThis applies mainly to medical research, although smoking or diet studies might interact.

 

Are there benefits to taking part in the research?

[Include a statement describing any benefits to the subject or others (science or society) that may be reasonably expected from the research. If there are no direct benefits to subjects, state that here. Payment or PEC for participation is not, in and of itself, a direct benefit of the research.] Subject pool people receive the benefit of the education your debriefing supplies.

 

What other options are there?

[Describe the appropriate alternative procedures or courses of treatment that might be advantageous to the subject. If there are no alternatives, as is the case in some survey research, this item need not be included in the consent form, however, the reason for not including this item should be explained in the research protocol itself.] This is not needed for subject pool; the alternative is not to bother. Remember, the subject gets the PEC even if he or she drops out…

 

Will I be told about new information that may affect my decision to participate?

During the course of the study, you will be informed of any significant new findings (either good or bad), such as changes in the risks or benefits resulting from participation in the research or new alternatives to participation that might cause you to change your mind about continuing in the study. If new information is provided to you, your consent to continue participating in this study will be re-obtained. This is unnecessary for a study that takes a single session. You are not going to rush into the middle of the session announcing that answering surveys causes cancer! It also may be omitted from some multi-session studies, where there are no such dangers remotely possible. This is really intended for medical studies in which the patient may be on an experimental drug that could be found to have unexpected side effects.

 

What about privacy and confidentiality?

Suggested text: (Remember to remove the note that this is suggested text) The only people who will know that you are a research subject are members of the research team. No information about you, or provided by you during the research, will be disclosed to others without your written permission, except:

- if necessary to protect your rights or welfare (for example, if you are injured and need emergency care or when the UIC Institutional Review Board monitors the research or consent process); or

- if required by law. This often scares people. If you are cannot reasonably get information about illegal activities, the law won’t intercede. If you are asking about such things, you may want a Certificate of Confidentiality. Anonymous or multiple-choice questionnaires may be safe, while open-ended interviews and focus groups, are not.

When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity. If photographs, videos, or audiotape recordings of you will be used for educational purposes, your identity will be protected or disguised. Don’t include this stuff about photos or tapes if you are not taking photos or making recordings!

Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. 

à If information will be released to any other party for any reason, state the person/agency to whom the information will be furnished, the nature of the information, and the purpose of the disclosure.

à If activities are to be audio- or videotaped, describe the subject's right to review/edit the tapes, who will have access, if they will be used for educational purpose, and when they will be erased.

à Describe the subject's right to review/edit the tapes, who will have access, and when they will be erased. Describe how personal identities will be shielded, disguised, etc.

à Give a brief description of how personal information, research data, and related records will be coded, stored, etc. to prevent access by unauthorized personnel.

à Explain how specific consent will be solicited, if any other uses are contemplated.

If applicable, state if and when individual responses to survey questionnaires will be destroyed, following analyses of the data

There is a distinction between confidentiality and privacy: confidentiality refers to the measures you take to protect the identities and data of your subjects; privacy refers to the subjects’ control over their own data and how it is used. Similarly, “anonymous” means no one can know who you were; “confidential” means no one outside the research will be told. (It could still be considered confidential if others see the data as long as they don’t have a way of associating it with individual subjects. It also would be possible for others to know who participated as long as they don’t learn any of the personal data such as what the participants said).

Bear in mind that you cannot promise this in a focus group because other participants in the group saw and heard. For focus groups, be sure to emphasize to participants that they should hold confidence, but that you cannot guarantee the compliance of other participants.

 

What if I am injured as a result of my participation?

In the event of injury related to this research study, treatment will be made available through the 

University of Illinois at Chicago Hospital. However, you or your third party payer, if any, will 

be responsible for payment of this treatment. There is no compensation and/or payment for such 

medical treatment from the University of Illinois at Chicago for such injury, except as may be

required of the University by law. If you feel you have been injured, you may contact the 

researcher, [add name] at[add phone number]. Use common sense. Subjects don’t get injured filling out questionnaires. On the other hand, a questionnaire may trigger depression or discomfort, and you may want to say what referral or action you will take.

Note that if a subject becomes suicidal, OAPS and Student Health are not appropriate places for emergency intervention. You should escort the subject to the UIC hospital (or other) Emergency room. The campus police can be called to send an officer to escort the subject. Never just point a suicidal subject toward the emergency room.

Suggested text: If the research is sponsored by a for-profit organization, identify the sponsor and describe the extent of compensation and/or payment for medical treatment available from the sponsoring company.

à The “Compensation for Injury” element is required if the research involves more than minimal risk. 

 

What are the costs for participating in this research?

[Include an explanation of additional research costs for which the subject will be responsible.] A simple “none” will suffice, but is probably not necessary for subject pool subjects who know they are not receiving a service. This is directed at medical work in which the subjects also get examinations, drugs, etc.

 

Will I be reimbursed for any of my expenses or paid for my participation in this research?

Guidelines:

à State whether the subject will be paid or offered other gifts (e.g., free care).If not, state this clearly.

à If the subject will receive payment, describe remuneration amount, when payment is scheduled and proration schedule should the subject decide to withdraw or is withdrawn by the investigator.

à If the subject will be reimbursed for expenses such as parking, bus/taxi, baby-sitter, travel companion/assistant, etc., list payment rates. 

The compensation for subject pool people is the PEC (Psychology Experience Credit). Please use the correct name for the acronym! They should know what that is. State how many credits they earn.

 

Can I withdraw or be removed from the study?

You can choose whether to be in this study or not. If you volunteer to be in this study, you may withdraw at any time without consequences of any kind. You may also refuse to answer any questions you don’t want to answer and still remain in the study. The investigator may withdraw you from this research if circumstances arise which warrant doing so. How vague! Give some idea of why (can’t do the task, funding lost, etc). If no one will be removed, leave out that sentence.

à If appropriate, describe the anticipated circumstances under which the subject's participation may be terminated by the investigator without regard to the subject's consent.

à If applicable, explain the consequences of a subject's decision to withdraw from the research and state whether withdrawal must be gradual, for reasons of safety.

à Be sure that this aspect of terminating participation at the request of the PI is also noted in the section on Payment for Participation, and that the information in both sections is consistent.

 

Who should I contact if I have questions? 

The researchers conducting this study are [add name(s)]. You may ask any questions you have now. If you have questions later, you may contact the researchers at: Phone: [add phone number(s)]

[If the researcher is a student, include the adviser's name and telephone number.] N.B.

 

What are my rights as a research subject?

If you have any questions about your rights as a research subject, you may call the Office for Protection of Research Subjects at 312-996-1711. 

 

What if I am a UIC student?

You may choose not to participate or to stop your participation in this research at any time. This will not affect your class standing or grades at UIC. The investigator may also end your participation in the research. If this happens, your class standing or grades will not be affected. You will not be offered or receive any special consideration if you participate in this research. (Fix the typo). This seems a strange question for subject pool.

 

What if I am a UIC employee?

Your participation in this research is in no way a part of your university duties, and your refusal to participate will not in any way affect your employment with the university, or the benefits, privileges, or opportunities associated with your employment at UIC. You will not be offered or receive any special consideration if you participate in this research. Subject pool people are there in their capacity as students, and any who are also employed need not be reminded about this.

 

RememberYour participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relations with the University or [insert the names of any other cooperating institutions as well]. If you decide to participate, you are free to withdraw at any time without affecting that relationship.

You will be given a copy of this form for your information and to keep for your records.

 

Signature of Subject or Legally Authorized Representative Subject pool people will never have a legally authorized representative. Competent adults in general do not have an authorized representative.

I have read (or someone has read to me) We assume our students can read English – but if a blind student could participate, this would apply--. the above information. I have been given an opportunity to ask questions and my questions have been answered to my satisfaction. I agree to participate in this research. I have been given a copy of this form.

                                                                         

Signature                                           Date

                                              

Printed Name

                                                                         

Signature of parent or guardian                  Date(must be same as subject’s)

                                              

Printed name of parent or guardian    This is strange! If they are adults, no parent signature is needed; if children, a separate permission form should be used. Note that in permission forms, it is useful to have a place to list the name of the person for whom permission is being granted!

                                                                         

Signature of Researcher                          Date (must be same as subject’s)

                                                                         

Signature of Witness (if appropriate)          Date (must be same as subject’s)

                                              

Printed name of Witness (if appropriate)     Witnesses are only needed if the subject is not competent to sign. Leaving this on the form scares away subjects (“gee, if a witness is needed, what am I getting into?”)

 

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