This is an anonymous and confidential survey for assessing pain knowledge and attitudes of healthcare providers and healthcare students who care for pediatric patients. Responses to this validated survey instrument will be used in local, national and international projects and responses will be stored in a central repository. Analysis of the survey responses may be used to assess educational needs across disciplines and in turn plan interventions to increase interdisciplinary sensitivity and competence in caring for pediatric patients with pain. Healthcare professionals and students may be surveyed longitudinally to assess changes and attitudes in level of knowledge across times or before and after a knowledge and attitude improvement effort.


To participate and include your data in a study involving this survey and the central repository, you were provided the anonymous survey link. Your participation is voluntary and it is nearly impossible for you to be identified by entering responses or failing to enter responses in the survey. The REDcapTM database is secure and data is only accessible to repository study personnel who have been assigned a unique username/password. All members of the research team will maintain confidentiality of all information enclosed. This survey is conducted in accordance with USA federal and Stanley Manne Children's Research Institute, affiliated with Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine research guidelines. There are no direct benefits to participants; and the risk of loss of confidentiality is limited by the anonymous completion of the survey and format of safeguards.

I have read the above information. I understand that completion of both the survey and demographics portion of this survey indicates consent for my responses to be included in the repository.

� Renee Manworren, 1999, revised 2014
� Manworren and Shriner's Hospital for Children Version, 2002, revised 2014


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