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INFORMED CONSENT

IRB APPROVAL NUMBER: 2007-10-066 EP

Project Identification: Communication Surrounding Miscarriage

Purpose: This research study seeks to understand communication, feelings, and emotions that occur surrounding a miscarriage. To participate in this study, you must be at woman who is at least 19 years old and has had a miscarriage within the last 5 years, and married at the TIME OF the miscarriage. You do not have to currently be married as long as you were married at the time of the miscarriage. The following information is provided to help you make an informed decision of whether or not to participate in this research. Please read this information carefully. If you should have any questions, please do not hesitate to ask.

Procedures: You will be asked to complete a questionnaire indicating brief demographic information such as your age and sex, and communication about your miscarriage. Questions ask you about your feelings surrounding your miscarriage and emotions that may have occurred. You will also be asked to write the story of your miscarriage experience. Total participation time is expected to be 50-75 minutes. Your questionnaire will have no personal identifying information connected to it.

Risks: Because of the sensitive nature of this study at the end of the survey there will be a list of online resources for you to consult if you wish to discuss your experience further. If this discussion should evoke any emotional discomfort during or after participation, please contact a counseling center in your area. You will be responsible for any counseling fees incurred.

Benefits: Participating in this study will provide you the opportunity to think about your feelings and experiences regarding communication about your miscarriage.

Confidentiality: The researchers will go to great lengths to protect your confidentiality. No identifying information will be linked to this questionnaire. The researchers will be the only persons with access to these responses. Further, your information will be stored on a secure website, and you may complete this questionnaire at your leisure. Your responses will be stored for up to two years. After three years, the data will be destroyed.

Compensation: You will not receive compensation for completing this study.

Questions: You may feel free to ask any question at any time during this research study. Please contact the researchers at leclairunderberg@hotmail.com or 402-472-0646 or Dr. Jody Koenig Kellas at jkellas2@unl.edu or 402-472-2079. If you have any questions about your rights as a research participant that have not been answered by the investigator or to report any concerns about the study, you may contact the University of Nebraska-Lincoln Institutional Review Board, telephone (402) 472-6965.

Freedom to Withdraw: You may withdraw from this study or refuse to answer any question at any time without affecting your relationship with the researcher or the University of Nebraska-Lincoln. Your decision will not result in any loss of benefits to which you are otherwise entitled.

Consent to Study: You are voluntarily making a decision whether or not to participate in this research. By clicking the “I Agree to Participate” option below, you are indicating that you understand the requirements to participate and agree to continue on to complete the questionnaire. It is recommended that you print off a copy of this screen for your records. If you agree to participate, please click the “I Agree to Participate” button below. If you do not want to proceed with this survey, please click the “Exit” option.

Cassandra LeClair-Underberg, University of Nebraska-Lincoln Office: (402) 472-0646

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