Consent

Sepsis HCP - Informed Consent_FINAL_9.12.19.docx

CDC and ATSDR Health Message Testing System

Consent

OMB: 0920-0572

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Sepsis Educational Effort - Informed Consent Script

Healthcare Professional Interviews

On behalf of the Centers for Disease Control and Prevention (CDC), ICF is conducting online interviews with healthcare professionals to gather feedback on educational materials to help raise awareness about sepsis. These materials were developed in partnership with CDC, and we hope to use what we learn from these interviews to improve these materials and/or develop new ones. The interviews will take place on an online platform and will be similar to an audioconference call. We expect this interview to take about 60 minutes.

We want to learn from you, so we encourage you to speak openly and honestly. There are no right or wrong answers. If you agree to participate in the discussion, here are some points to know:

  • Rights Regarding Participation: Your participation in this discussion is completely voluntary. You may choose to leave the interview and/or not answer a question at any time for any reason. Refusal to participate will involve no penalty or loss of benefits.

  • Privacy: We will take every precaution to protect your identity and ensure your privacy. We will keep your name and answers to these questions private. Your name and contact information will be kept separate from any interview responses. We will never use your name in any reports.

  • Benefits: Your participation in this interview will not result in any direct benefits to you. However, your input will help us to develop and improve educational materials about sepsis for healthcare professionals like you.

  • Risks: There is no known risk to you from your participation in this interview. Although we have made every effort to remove any risk to you from participating in this interview, you may decide not to answer any questions that make you feel uncomfortable in any way.

  • Incentive: In appreciation of your time and participation, the recruiter will give you $XX as a token of appreciation for participating in today’s interview.

  • Recording: This discussion will be recorded. Again, no quotes or comments you make will be linked with your name in any way. We will also take notes throughout our interview today. We will keep all information, notes, and recordings locked in a secure computer file until the end of the project, when the notes and recordings will then be destroyed. Only study staff will be able to access the information.

  • Observers: Individuals from CDC will be observing this discussion silently. They will not participate in the discussion. All observers have completed human subjects research training related to participant privacy and confidentiality.

  • Questions: We will answer any questions you have about this online interview before you take part.

  • Contact Information: If you have any questions about this discussion or the campaign, please contact the research director, Kristen Cincotta, PhD, at 404-320-4433. If you have questions about your rights as a participant in this focus group, please contact the chair of ICF’s Institutional Review Board (IRB), Carole Harris, at (404) 321-3211.

Do you consent to participate in the interview? Yes No

Do you agree to be recorded during this interview? Yes No



Name (please print): ___________________________________________________________________

Signature: ______________________________________________ Date: ___________________

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