Principal Investigator: Katherine L. Wisner, MD, MS
Northwestern IRB Study Number: STU00211497
Please read this information sheet carefully. It provides important information about our survey.
• This survey is being done to understand the needs of people who have epilepsy and depression or anxiety. We would like to understand treatments that have been offered and treatment options they would be interested in. We are offering you the chance to take this survey because you are a person with epilepsy, you are related to or care for a person with epilepsy.
• You must be at least 18 years old to take this survey.
• This survey is taking place through Northwestern University. This survey is not funded.
• If you choose to participate, you will be asked to complete a survey about depression, anxiety and treatment options. It will take about 5-10 minutes to complete this survey. Feel free to skip any questions that you do not wish to answer, or close out of the survey if you do not wish to complete it. Your input is entirely voluntary.
• This survey is conducted through REDCap, a secure, web-based application designed for research studies. No information that will identify you is collected on the survey We will not obtain any information from your medical records. Only our staff will have access to your responses. A summary of the survey responses may be used to justify new treatments or to support future research about improving the quality of care. Please do not share any information in your answers that would potentially identify you or other individuals. If you do, there is a potential risk of loss of confidentiality.
• There are no risks associated with this survey.
• There is no monetary compensation for completing the survey.
• Participation is voluntary; you can stop taking part in the survey or close out of the survey browser at any time. You can skip any survey question you do not want to answer.
• Deciding not to participate in this survey will not affect any medical care that you receive now or in the future, or any benefits you receive now or have a right to receive.
• Katherine L. Wisner, MD, MS is the principal investigator of this survey and can be reached at (312) 695-8441 during the hours of 9:00 a.m. to 5:00 p.m., Monday to Friday. You may leave a message and provide your contact information if you do not reach her immediately.
• If you’d like to speak to someone not involved in this research or have questions about your rights as a research subject, please contact the Northwestern University Institutional Review Board (IRB) Office at (312) 503-9338 or by email at irb@northwestern.edu.
• Thank you very much for considering filling out the survey. If you agree to the above terms, please complete the survey on the following page.