Affecting Psychosocial Adjustment”
Investigators – Jeffrey
Doucette RN (student investigator), University of Massachusetts,
Lowell; 603-867-5459 or email Jeffrey_doucette@uml.edu.
Barbara Mawn PhD RN, 978-934-4485 or email Barbara_mawn@uml.edu.
You may contact the investigators with any concerns or questions
about this study.
– This study is designed to gather information about ostomy
patients and their experience of adjusting to having an ostomy.
This study may help nurses and other health providers to better
assist people with a new ostomy. Your choice to participate or not
to participate in this study will not influence the health care
you receive or affect the relationship you have with your health
Explanation of the
Procedure – You are being asked to complete a survey
that will provide the researchers with personal and health-related
information, such as age, marital status and type of stoma, and
important information about adaptations you have made to live with
an ostomy. It will take approximately 15-20 minutes to complete
the questions. You can skip any questions that you do not want to
Although we believe the questions we are asking will not cause you
distress, there is always some slight risk that you might find
them upsetting or otherwise stressful. If you feel stressed, you
may stop the survey at any time.
You will receive a $10 Dunkin, Panera Bread, or Market Basket gift
card by mail. You will need to complete the incentive information
at the end of the survey in order to receive the incentive. If you
decide not to complete the entire survey, you can still receive a
gift card by completing the incentive information.
There are no direct benefits to you by participating in this
study. The study will help us to better understand the experiences
and some of the challenges people with an ostomy report. This
information may help nurses and other health care workers to
better understand factors that affect adapting to an ostomy and
will hopefully improve the care we provide for ostomy patients in
Assurances of Privacy –
You will not be asked to provide your name or any other
identifying information within the survey. All information will be
secured in a locked cabinet or password-protected computer. Your
identity will be kept confidential and will not be revealed.
Right to Refuse
– You are free to withdraw from the survey at any time and can
skip any question or questions you do not want to answer.
I understand the potential
risks and/or discomforts that have been described in this document
and by the researcher. By completing this survey, I am indicating
that I am 18 years of age or older, I have read this document, had
the opportunity to discuss any concerns and ask any questions
about the research, and understand the risks and consequences from
participating in this study. I agree to participate in this