CLAE WWE Survey - English

Canadian Practitioner Consent

Implied Consent Form
 
Study Title: A survey of Canadian practice in the management of women with epilepsy


Principal Investigator: Tadeu Fantaneanu 
Division of Neurology, Department of Medicine
Tel: 613 798 5555 xt 17932
Fax: 613 761 5360

OHSN-REB Number: 20200747-01H
 
You are being asked to participate in a research study that we are conducting.  Participation is voluntary. Your office fax number was obtained from Scott’s Medical directory in order to help us reach you as a potential participant.
  
 
Why is this study being done?
The care of Women with Epilepsy (WWE) is complex and especially important during their childbearing years.
There is felt to be a heterogeneity in practice across Canada in how neurologists, epilepsy specialists or nurse practitioners approach this patient population.
We wanted to sample this diversity in practice by way of a questionnaire.
 
What does participation in the study involve?
We will ask the participants to complete a short 7-minute survey about their current practices in the care of WWE.
 
 
What are the risks?
There are no major risks associated with participating in this study. You may feel uncomfortable answering some questions however you can refrain from answering any question at any time.
 
What are the benefits?
By taking part in these sessions, you will have the opportunity to inform different organizations such as the Canadian League Against Epilepsy (CLAE), Canadian Neurological Sciences Federation (CNSF) and Canadian Epilepsy Nursing Group (CENG) on how WWE are currently managed in Canada.
 
Gaps in care will be identified and additional training materials may be developed to address these gaps and ensure all WWE receive the most up to date, standard of care available.         
                                                                                    
Do you have to participate?
Your participation is voluntary and choosing not to participate will have no effect on your current or future relationship with any of the above-cited organizations in the future.
 
Study Costs
You will not be paid for participating in this study.
 
What about confidentiality and privacy?
Your confidentiality and privacy will be protected at all times unless release is required by law.  No personal health identifiers are collected during this survey. Fax information contained on the submitted questionnaires will be redacted by an assistant before being presented to the study investigator.
 
How are the findings to be shared?
We will make every effort to ensure the findings of this strategy are shared in a timely manner with Canadian practitioners taking care of WWE. We will also present outside the university communities at various professional conferences and through publications. 
A summary will also be published on the CLAE website.
Questions about the study
If you have any questions about this study, please feel free to contact Dr. Tadeu Fantaneanu, whose coordinates may be found below.
Address: 1053 Carling Ave, C2 Neurosciences clinic, C2194
Ottawa Ontario, K1Y 4E9
Tel: 613 798 5555 xt 17932
Fax: 613 761 5360
 
If you have questions about your rights as a participant or about ethical issues related to this study, you can talk to someone who is not involved in the study at all. Please contact The Ottawa Health Science Network Research Ethics Board, Chairperson at 613-798-5555 extension 16719. 
 
If you would like to participate in this study please complete the survey and fax back to 613-761-4752.
 
By completing the survey you are providing your consent to participate in the study.
 
Thank you,                                                                                         
Tadeu A. Fantaneanu, MDCM, CSCN (EEG), FAES, FRCPC.                                                       
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