Study Consent

What is the study about?

You are being asked to participate in a research study about the experiences of pain and nausea among
women with metastatic breast cancer. The goal of this survey is to better understand your experience with
pain and nausea, and the impact that these experiences have on your life. You are being asked to take part
because you are a woman who has been diagnosed with metastatic breast cancer.

Do I have to participate?

No, you do not have to take part in this study. Participation is voluntary. Your decision will not affect the
services you receive from the Cancer Support Community (CSC). If you choose not to take part in the study
or withdraw, you will still be able to receive any services provided by the Cancer Support Community.
Refusing to participate or withdrawing will not involve any penalties or loss of benefits to which you are

What happens if I say ‘yes’?

If you say yes, you will take part in an online survey to answer questions about pain, pain management,
nausea, and the cancer experience. The information provided from survey responses will be used to help
CSC understand how pain and nausea impact the lives of women with metastatic breast cancer. The survey
should take approximately 30 minutes to complete. Your participation in this study will end at the
conclusion of the survey. You can stop answering the survey questions at any time with no penalty. Your
alternative to taking part in this study is to choose not to take part in the study.

What will this cost me and will I get paid to participate?

There is no cost to take part in the survey. There will not be any payment given for participation in this

What is the benefit of participating?

You may not receive a direct benefit from being in this study. Your participation will help improve
understanding of pain and nausea among women with metastatic breast cancer, which could help expand
knowledge surrounding side effect preferences and treatment decision-making.

Is there any risk to participating in the study?

It is possible that you may find answering some of the questions upsetting. You don’t have to answer any
question that you don’t want to answer. You can choose not to take part or leave the study at any time
without penalty. In the event you should need social and/or emotional support, Cancer Support
Community has a toll free helpline, which you can access over the phone at 888-793-9355, and free
informational resources, which can be accessed online at There is also
a minimal possibility of loss of privacy or confidentiality.

Could I be removed from participating in the study?

You will be removed from the study if is determined that you do not meet the eligibility requirements. You
must be at least 18 years of age with a cancer diagnosis and be able to communicate in and understand

How will my identity be protected?

There is a minimal possibility of loss of privacy or confidentiality. However, research records will be kept
private according to all local, state, and federa
Who is conducting the study?

The study is being directed and managed by the Cancer Support Community’s Research and Training
Institute and sponsored by Charleston Laboratories, Inc.

What if I have questions about the study or my rights as a research participant?

If you have any questions about this study, or if you feel like you have been harmed by taking part in the
study you should contact the study lead, Linda House, RN, BSN, MSN, at 1-202-650-5382 or email her at

If you have questions about your rights, would like to offer input, or have any complaints that you feel you
cannot take to Ms. House, you may call an impartial reviewer, Ethical & Independent Review Services (E&I)
IRB at 1-800-472-3241, or email at E&I is a group of people that looks out for
the rights and welfare of research participants.

This makes sense to me, so what do I do now?

If you agree to take part in this study, you will need to provide consent. Please contact CSC to ask questions
if you have any questions about taking part in this study prior to consenting. If you agree, please print a
copy of this for your records.

Question Title

* 1. By clicking “YES” below, you agree to take part in this research study and continue to the survey.