CONSENT FOR PARTICIPATION IN PILOT PROJECT
Project Title: REACH Community-based Supportive Cancer Care: A Pilot Project
Project Description: The primary objective of the REACH (Resources, Encouragement & Accessible Cancer Support for Healing) pilot project is to establish targeted referral pathways from within communities where individuals with a cancer diagnosis may encounter multiple barriers to accessing vital supportive care following their diagnosis.
In addition to providing targeted support, we aim to continually learn and understand what individuals want and need for their ongoing supportive cancer care. This will help us to adapt and customize our programs and resources accordingly over the coming months and years.
Purpose of Feedback: I consent to participating in the above-mentioned pilot project. I understand that my participation involves the collection of information about my satisfaction with the program for the following purposes:
1. To assess the impact of the pilot project on my wellbeing.
2. To gather feedback to improve future services in the community.
Feedback collection and use: I understand that as part of this pilot project feedback will collected at the beginning and the end of the pilot project. This will involve:
1. Short survey at the beginning of the pilot project.
2. Short survey at the end of the 6-month pilot.
Compensation:
I understand that I will receive a $25 gift card in compensation for my time to complete the initial survey and a further $50 gift card for my time to complete the final survey and interview.
Confidentiality:
I understand that all information I share will be kept confidential and secure. My information will be made anonymous to the evaluators of the project.
Withdrawal from the Pilot Project
I have the right to withdraw my consent and discontinue participation in the pilot project at any time without any negative consequences. If I choose to withdraw, I understand that any feedback collected to date will be used as outlined above.
Questions and contact information:
If I have any questions about the pilot project at any time I can contact:
Contact name: Jill Burns
Contact phone # 613 247 3527 ext. 229
Contact email: [email protected]
