We are asking you to participate in a research study. This form is designed to give you
information about this study. We will describe the study to you and answer any of your
questions.
Project Title: Parenting an Adolescent or Young Adult Child with Cancer
Principal Investigator:
Tracey A. Revenson, PhD
Professor, Hunter College, City University of New York
695 Park Avenue, Hunter East, Room 1201
New York, NY, 10065
212-396-6769
trevenson@gc.cuny.edu
Project Director:
Aliza A. Panjwani, MA
Doctoral Student, Graduate Center, City University of New York
365 5th Avenue,
New York, NY, 10016
apanjwani@gradcenter.cuny.edu
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Purpose: You are invited to participate in a study of parenting an adolescent or young
adult child with cancer. The goal of the study, conducted by Dr. Tracey Revenson and
her doctoral student Ms. Aliza Panjwani, is to better understand the unique experiences
and needs of parents of adolescent and young adult children with cancer, and how they
might change over time. The information you provide will help develop future programs
to support parents experiencing similar challenges. To be eligible:
- Your child had to have been diagnosed with cancer between the ages of 14-39.
- Your child must currently be between the ages of 14-39.
- You must feel comfortable understanding and answering the survey questions in English.
If you agree to participate, you will be asked to complete an Internet survey about your
experience as a parent of an adolescent or young adult child with cancer. You will be asked
about how you have been feeling physically and emotionally and how you have been coping.
You will also be asked to provide information about yourself and your child, such as age,
ethnicity, and income. At the end of the survey, you will be asked to indicate if we can contact
you again in about a year to complete a follow-up survey.
The survey will take you approximately 45 minutes to complete and you will be entered into a
raffle to win a $30 dollar e-gift card. Please note that multiple submissions will not increase
your chances in the raffle. We will be taking steps to verify that same person is not completing
the survey multiple times. If you are discovered to be submitting the survey multiple times,
we will have to remove your responses from the study and you will be disqualified from the raffle.
These steps will be taken in order to provide each participant an equal and fair chance at winning
the raffle.
The only possible risk involved in participating is that you may find it temporarily upsetting to think
about issues around parenting your child with cancer. The information you provide will be kept
private on a protected computer network in Dr. Revenson’s office suite at Hunter college,
accessible only to research staff and the Hunter college ethics board. You will be identified in the
database only with a subject ID. We will keep your consent information separate from your
survey responses so that no one can identify you. Data will be stored for future use by the
Dr. Revenson and her doctoral students.
Your participation in this research is voluntary. If you have questions about the research,
you can contact the Principal Investigator, Dr. Tracey Revenson at (212) 396-6769 or by
email at trevenson@gc.cuny.edu. If you have questions about your rights as a research participant or if you would like to talk to someone other than the researchers, you can contact
CUNY Research Compliance Administrator at (646) 664-8918. If you want to print this page
to keep a copy of your consent, please do so at this time.
______________________________________________________________________
Instructions: Before clicking ahead to indicate your consent, be sure you have adequate time
to finish. You will need approximately 45 minutes to complete the survey. If you don't have
enough time now, please do not start this survey at this time and return to it at a later time.
Please complete the survey by yourself. Consider going to a place that is quiet, where you
feel you have privacy, and where you won't be distracted. If you are in a public place, be sure
to completely log off once you have finished your survey. Doing so will keep your responses
private.
Statement of Consent: “I have read the above description of this research and I understand it.
I have been informed of the risks and benefits involved, and all my questions have been
answered to my satisfaction. Furthermore, I have been assured that the Principal Investigator
of the research study will answer any future questions that I may have. By clicking "yes" to
the statement below, I have not waived any of my legal rights to which I would otherwise be
entitled."