Saybrook Informed Consent Form

Introduction:   My name is Lisa Jones.  I am a doctoral student at Saybrook University in California. I would like to find out if more education about complementary medicine therapies will have an effect on medical personnel beliefs, referring these practices to patients, and talking with patients about these therapies. 
 Activities:  If you participate in this research, you will be asked to: 1)Complete an online survey about feelings on complementary medicine therapies and to provide demographic information. This should take about 10 minutes, 2)Review a 30 minute taped presentation, 3)Complete an online survey after review of the presentation about feelings on alternative treatments. This should take about 10 minutes. When you have finished all three parts, you will receive a $50 Amazon gift care.
Eligibility:  You are eligible to participate in this research if you are: 1. A student of an accredited nurse practitioner or physician assistant program in the United States, and 2. Native English-speaker. You are not eligible to participate in this research if you do not meet the requirements stated above. I hope to include 24 participants in this research, 12 of each group.
Risks:  There are minimal risks in this study.  Some possible risks include: your identity becoming known. To decrease the impact of these risks, you can: skip any item in the survey, and/or, stop participation at any time.
Benefits:  If you decide to participate, the direct benefits to you are increased awareness of proven studies relating to alternative treatment practices.  The potential benefits to others are: a better idea if increased awareness will have an impact on feelings, suggesting other practices, and talking with patients about complementary medicine therapies.
Confidentiality:  The information you provide will be kept confidential to the extent allowable by law.  Some steps I will take to keep your identity confidential are:  I will not use your name to identify you in the final paper, and I will keep your name separate from your answers. The only person who will have access to your information is me. I will secure your information with these steps: locking it in a filing drawer, and/or, locking the computer file with a password. I will keep your data for 7 years. Then, I will delete electronic data and destroy paper data.

* 1. Contact Information:
If you have questions for me, you can contact me at: or 513-226-6468.
My dissertation chair’s name is Dr. Devorah Curtis.  She works at Saybrook University and is supervising me on the research.  You can contact her at: If you have questions about your rights in the research, or if a problem has occurred, or if you are injured during your participation, please contact the Institutional Review Board at: or 510-593-2935

* 2. Voluntary Participation: Your participation is voluntary.  If you decide not to participate, or if you stop participation after you start, there will be no penalty to you.  You will not lose any benefit to which you are otherwise entitled.

Signature: Your typed name indicates your understanding of this consent form.

* 3. Please enter your email:

* 4. What is your age?

* 5. How many years have you studied in this NP/PA program?

* 6. How much formal education have you received regarding complementary medicine practices?

* 7. How much time have you spent in an educational internship for NP/PAs?

* 8. Have you received treatment from an alternative practitioner?

* 9. If yes, please detail types of treatment.

* 10. Please answer the following questions. Please note that although the questions state physician, the survey is intended for any medical practitioner. It is a subset of the questions used on the Integrative Medicine Attitudes Questionnaire (IMAQ). You may choose not to answer any question that contains information which you do not wish to disclose.
Please select your response to the following questions. 1 Strongly disagree - 7 Strongly agree

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The physician’s role is primarily to promote the health and healing of the physical body.
Patients whose physicians are knowledgeable of multiple medical systems and complementary and alternative practices , in addition to conventional medicine, do better than those whose physician are only familiar with conventional medicine.
Physicians should warn patients to avoid using botanical medicines (herbs) and dietary supplements until they have undergone rigorous testing such as is required for any pharmaceutical drug.
It is appropriate for physicians to use intuition  (“gut feelings”) as a major factor in determining appropriate therapies for patients.
It is irresponsible for physicians to recommend acupuncture to patients with conditions like chemotherapy-related nausea and vomiting or headache.
It is not desirable for a physician to take therapeutic advantage of the placebo effect.
Physicians knowledgeable of multiple medical systems and complementary and alternative practices (i.e., Chinese, Ayurvedic, Osteopathic, Homeopathic, etc.), in addition to conventional medicine, generate improved patient satisfaction.
Therapeutic touch has been completely discredited as a healing modality. 
Quality of life measures are of equal importance as disease specific outcomes in research.        
Chiropractic is a valuable method for resolving a wide variety of musculoskeletal problems (beyond back pain).
Massage therapy often makes patients “feel” better temporarily, but does not lead to objective improvement in long-term outcomes for patients.
Physicians should be prepared to answer patient’s questions regarding the safety, efficacy, and proper usage of commonly used botanical medicines such as Saw Palmetto, St. John’s Wort, Valerian, etc. 
Physicians should avoid recommending botanical medicines based on observations of long-term use in other cultures and systems of healing, because such evidence is not based on large randomized controlled trials.
Osteopathic manipulative therapy is a valuable method for resolving a wide variety of musculoskeletal problems (beyond back pain).
Information obtained by research methods other than randomized controlled trials has little value to physicians.
It is ethical for physicians to recommend therapies to patients that involve the use of subtle energy fields in and around the body for medical purposes (i.e. Reiki, Healing touch, Therapeutic touch, etc.)