Online Consent for Survey

Shared Decision Making: Bridging the Gap between Patient Expectations and Outcomes

A Feasibility Study

Kimberly Gregory, MD

Phone: (310) 423-5420.


You are being invited to complete a survey that is part of a research study conducted by the Maternal Quality of Care Indicator (MQI) Working Group. MQI is comprised of independent clinicians and research scientists who have joined together to improve both childbirth safety and the quality of care received by mothers and babies.


The goal of this phase of the study is to better understand what matters most to women about their care during pregnancy and birth, who they trust when seeking information and making decisions, and where they go to gather that information. If you agree to participate, the survey should take you no longer than 15 minutes.

Participant Requirements

Participation in this study is limited to adult and adolescent women who are pregnant or plan to become pregnant.


The risks and discomfort associated with participation in this study are no greater than those ordinarily encountered in daily life or during other online activities. No identifying information will be requested from you.


There may be no personal benefit from your participation in the study. However, we hope this study will benefit patients in general by looking at different and new ways to provide people with decision support tools for healthcare services.


Upon agreeing to participate, you will not be required to provide any identifying information. Although every reasonable effort has been taken to ensure that your information is encrypted, confidentiality during the actual internet communication procedure cannot be guaranteed.

The data and information gathered during this study may be used by the investigator and published and/or disclosed outside of Cedars-Sinai Medical Center in publications or other dissemination of the research data.

Right to Ask Questions & Contact Information

If you have any questions about this consent form or the study, you should feel free to ask them by contacting the Principal Investigator by mail, phone or e-mail as noted in the contact information listed above. If you use e-mail, you should be aware that confidentiality during the transmission process cannot be guaranteed. Therefore, we do not suggest using email to relay any private or sensitive information.

If you have questions regarding your rights, concerns, or complaints about taking part in this study, please contact:

CSMC Institutional Review Board (IRB)
Phone: (310) 423-3783

The CSMC IRB has been established to review, approve, and monitor all human research at CSMC with the purpose of minimizing risks and protecting the rights and welfare of research participants.

Voluntary Participation

Your participation in this research is voluntary. You may discontinue participation at any time.
If you have any questions or concerns about the information in this consent form or about this study, you should not agree to participate until all of your questions have been answered. Please contact the following individual before proceeding:

Dr. Kimberly Gregory MD, (310) 423-5420


The next four questions are required assurances to participate in the survey. If the answer is no, the individual cannot participate.