Activate an optimized version of the page designed specifically for screen readers.
Outdated browsers can expose your computer to security risks. To ensure a secure experience, we recommend updating to the latest browser version. Support for this browser version will soon be discontinued.

University of Denver

Consent Form for Participation in Research 


Title of Research Study: Mental and Physical Well-Being of Caregivers of Lung Cancer Patients and Survivors


Researcher(s): Trisha Raque-Bogdan, Ph.D. (University of Denver), Amanda Ginter, Ph.D. (Towson University)


Study Site: Online survey




This is a research project being conducted by Trisha Raque-Bogdan, Ph.D., at the University of Denver and Amanda Ginter, Ph.D., at Towson University.  We are interested in your responses to this survey because you are a person over the age of 18 who is a romantic partner and caregiver for someone diagnosed with lung cancer in the last 2 years. The purpose of this study is to learn more about the unique challenges faced by caregivers. 




If you agree to be part of this online research study, you will be asked to complete an online survey at 2 different time points over the course of six months (initial time point and 6 months later).  In total, this study is anticipated to require 1 hour of your time over the course of the six months (approximately 30 minutes for each of the two surveys).  The survey questions will ask you about your feelings about your quality of life as a caregiver, your physical health, and the physical health of the lung cancer survivor for whom you are a caregiver.



Voluntary Participation

Your participation in this survey is completely voluntary. You may ask questions or withdraw from survey participation at any time without penalty.



Risks or Discomforts

The main possible risk from participating in this survey is that the questions might elicit negative emotions (e.g., sadness about your partner’s cancer diagnosis and your caregiving responsibilities).  Contact information for psychological resources and resources on cancer and caregiving will be provided at the end of each survey.




Although this research is not intended to benefit you directly, its findings will help the investigator learn more about the unique strengths and challenges faced by caregivers of lung cancer survivors.  Your responses will be contributing to research on an important area of study.


Incentives to participate

If you would like, after each survey you can submit an email address into a lottery to win one of three $50 Amazon electronic gift cards.  The electronic Amazon gift certificates will be sent to the randomly selected three winners, and will require that you provide an email address to which the gift certificate can be sent.  Participant names and email addresses will be stored in a separate database from survey responses so that data analysis will not involve participant names and email addresses in any way.  Once the Amazon gift certificate has been sent out, participant names and email addresses will be deleted from the data. 




The survey does not ask for identifying information except for the email address for the electronic gift certificate, and the confidentiality of your answers will be protected as best as possible. Due to the public nature of the Internet, absolute confidentiality cannot be promised. The likelihood of someone accessing your data is very improbable but a theoretical possibility.


Please be mindful to respond in private and through a secured Internet connection for your privacy. Your confidentiality will be maintained to the degree permitted by the technology used. Specifically, no guarantees can be made regarding the interception of data sent via the Internet by any third parties. Be sure to exit or close your Internet browser when you have completed the survey to ensure that another person using that same computer cannot see your responses.  


The data that you provide will not contain any identifying information and will be stored on a password-protected computer.  The researchers will retain the data for five years after the study’s completion.


The results from the research may be shared at a meeting and may be published in articles but only in a combined or summative form (i.e., not highlighting any individual responses). 


However, should any information contained in this study be the subject of a court order or lawful subpoena, the University of Denver might not be able to avoid compliance with the order or subpoena. The research information may be shared with federal agencies or local committees who are responsible for protecting research participants.




If you have any questions about this project or your participation, please feel free to ask questions now or contact Trisha Raque-Bogdan at at any time.


If you have any questions or concerns about your research participation or rights as a participant, you may contact the DU Human Research Protections Program by emailing or calling (303) 871-2121 to speak to someone other than the researchers.



Please take all the time you need to read through this document and decide whether you would like to participate in this research study.

If you decide to participate, your completion of the research procedures indicates your consent.  Please keep this form for your records.