1. Default Section

1. Your participation in this study is entirely voluntary. If you choose not to participate, there is no penalty. Refuals to participate will not affect your health care at California Pacific Medical Center (CPMC). There may be no direct benefit to you from taking part except the knowledge that you are helping us learn more about stress in caregivers. There is no cost to you, and you will not be paid for taking part. You may refuse to answer any individual question. We will keep all of your answers confidential, and we will not disclose any information about you unless the law requires us to do so. Your name will never appear in any report of the study. If you have any questions about your rights as a participant, you can contact the Sutter Health Institutional Review Board for the Protection of Human Subjects at (415) 600-3688.

Thank you for taking the time to participate in this study. We would first like to ask you a few questions to gather some general information about caregivers. After that we would like to ask you some questions about stress related to caregiving.


2. What is your email address?

Please provide the same email address each time you complete the survey so that we can track your results. This is the email address at which you will receive study related emails.
Please note that we will not disclose your email address to anyone not affiliated with this study.
Your email address will also be deleted from our records at the end of the study.

3. What is your sex?

4. How old are you?

5. What is the primary diagnosis of the person you are providing care for (for example Alzheimer's disease, stroke, ALS, etc)?

We would now like to ask you a few questions about stress in your life. We know that providing care for someone with a chronic illness is very stressful. We are interested in finding out what feelings are more common and if the use of Relaxation and Guided Imagery (RGI) can help caregivers take better care of themselves.

As a result of your caregiving responsibilities, which of the following are true and how often?

6. I have bad dreams or trouble sleeping.

7. I don't have enough time for myself.

8. I am easily angered or irritated.

9. I feel guilty about my situation.

10. I find it more difficult to enjoy myself now.

11. I have conflict with the person I care for.

12. I have conflicts with other family members.

13. I find it hard to ask for help.

14. I find worry about the future interferes with my ability to set goals.

15. I don't have confidence in my ability as a caregiver.

16. I am concerned about my own health.

Thank you for taking the time to participate in our research study. If you wish to submit your answers please read the paragraph below, check "I understand", and click the "Done" button.