Pet Bereavement Study

Statement of Informed Consent

A. PURPOSE AND BACKGROUND Researchers from Palo Alto University are conducting a study to learn about the impact of losing a pet. The investigators are Wendy Packman, JD, PhD and Nigel Field, PhD. It is hoped that the information they learn will assist in providing comprehensive care for grieving individuals and families. You are being asked to participate in this study because you have lost a pet. You are eligible to participate in this study if you are 18 years or older and are English-speaking.

B. PROCEDURES If you agree to be in the study, you will complete 7 questionnaires concerning your experiences of the death of your beloved pet, your psychological adjustment and your experiences in close relationships. It should take approximately one hour (50-60 minutes) to complete these questionnaires.

C. RISKS/DISCOMFORTS

1. Completion of the measures about your companion animal who has died may be upsetting and bring up painful memories. Please note that the majority of questions require an answer. On those questions that are optional, you are free to answer, or not to answer the questions. You have the right to decline to participate or to withdraw at any point in this study. If you should experience discomfort beyond a level that you are able to handle, you are encouraged to use the referral resources offered on this website.

2. Confidentiality: Your research records will be handled as confidentially as is possible within the law. Special precautions will be taken to protect the identities of participants in the study and the confidentiality of all information provided. You WILL NOT be asked to reveal any type of personally identifying information, such as your name, social security number, phone number, or email address. No other identifying information, such as your computer's IP address will be recorded or stored. Only the study investigators will have access to your responses. The survey does include "open-ended" questions, which encourage participants to discuss some of the topics addressed in this study more broadly. Participants are strongly encouraged not to reveal any information that
could be personally identifying in the open-ended portions of the study. No individual identities will be used in any reports or publications resulting from this study, and should you reveal any personally identifying information in an open-ended question, this information will be removed in any reports or publications. Brief quotations from open-ended questions may be used in reports or publications, otherwise, data from this survey will be reported in aggregated form.

D. BENEFITS There will be no direct benefit to you from participating in this study. However, the information that you provide may help professionals better understand persons’ experiences surrounding the death of their companion animal.

E. PAYMENT You will not be paid for participating in this study.

F. QUESTIONS If you have further questions, you may contact Dr. Packman at 650-433-3827, or you may email Dr. Packman and her research assistants at petlossstudy@gmail.com

Questions about your rights as a participant in this study may be presented to the IRB Chair, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 (Phone – 650-433-3870).

G. REFERRAL SOURCES Referral sources will be presented after the survey, or you may view them by going to

 PetLossSupportPage

 PetLossHotlines

 AssociationofPetLossandBereavement
Pet Loss Chat Room:
Monday/Tuesday/Wed/ Friday
8:00-10:00 p.m. (Eastern Time)
Sunday
2:00-4:00 p.m.(Eastern Time)

H. CONSENT You may print copies of this consent form to keep.

PARTICIPATION IN THIS RESEARCH IS VOLUNTARY. You are free to decline to be in this study, or to withdraw from it at any point.

At any time during the survey, click on the previous button to return to this page.

If you agree to participate, please press the "Yes/agree" button below. Otherwise, press the "No/disagree" button and you will be directed away from this site.