Physician Perceptions and Attitudes Regarding Aspirin Prescribing for the Prevention of Preeclampsia in Women with Inflammatory Bowel Disease

                                         CONSENT TO PARTICIPATE IN A RESEARCH STUDY
                                                       PHYSICIAN CONSENT FORM
Title Physician and Patient Perceptions and Attitudes Regarding Aspirin for the Prevention of Preeclampsia in Women with Inflammatory Bowel Disease

Investigator       Dr. Vivian Huang, MD, FRCPC
                            Mount Sinai Hospital
                            441-600 University Avenue Toronto, ON
                            M5G 1X5
                            416-586-4800 ext. 2475

Co-Investigators   Dr. Cynthia Maxwell, MD, FRCSC

Sponsor                 N/A


You are being asked to take part in a research study. Please read this explanation
about the study and its risks and benefits before you decide if you would like to take
part. You should take as much time as you need to make your decision. You should ask
the study doctor or study staff to explain anything that you do not understand and make
sure that all of your questions have been answered before signing this consent form.
Before you make your decision, feel free to talk about this study with anyone you wish.
Participation in this study is voluntary.

Background and Purpose

You are being asked to take part in a research study because you are a physician who
may have cared for patients with inflammatory bowel disease (IBD). We are looking to
assess physician thoughts and attitudes in relation to Aspirin for the prevention of
preeclampsia in women with IBD.

Study Visits and Procedures

Your participation in this study requires the completion of an online survey, which will be
completed through Novi Survey, a secure online survey platform. The online survey
should take 5-10 minutes to complete. You will be asked to complete a
questionnaire consisting of the following:
a) Demographics: You will be asked to provide demographic information including
demographics, practice setting and comfort level in caring for patients with IBD

b) Aspirin Questionnaire: You will be asked to complete this questionnaire to assess
your thoughts on Aspirin for the prevention of preeclampsia (i.e. side effects,
potential benefits)

Risks Related to Being in the Study

There are no medical risks if you take part in this study but being in this study may
make you feel uncomfortable. You may refuse to answer questions or end the survey at
any time if there is any discomfort

Benefits to Being in the Study

You may not receive any direct benefit from being in this study. Information learned
from this study may help other people with IBD in the future.

Voluntary Participation
Your participation in this study is voluntary. You may decide not to be in this study, or to
be in the study now and then change your mind later. You may leave the study at any
time without affecting your employment status. You may refuse to answer any question
you do not want to answer, or not answer an interview question by saying “pass”.
We will give you new information that is learned during the study that might affect your
decision to stay in the study.

Alternatives to Being in the Study

The choice to join this study is completely voluntary.


The information that is collected for the study will be kept in a locked and secure area
by the study doctor for 7-10 years. Only the study team or the people or groups listed
below will be allowed to look at your records.

All information collected during this study, including your personal health information,
will be kept confidential and will not be shared with anyone outside the study unless
required by law.

You will not be named in any reports, publications, or presentations that may come from
this study.

If you decide to leave the study, the information about you that was collected before you
left the study will still be used. No new information will be collected without your
In Case You Are Harmed in the Study

If you become ill, injured or harmed as a result of taking part in this study, you will receive
care. The reasonable costs of such care will be covered for any injury, illness or harm that is
directly a result of being in this study. In no way does signing this consent form waive your
legal rights nor does it relieve the investigators, sponsors or involved institutions from their
legal and professional responsibilities. You do not give up any of your legal rights by signing
this consent form.

Expenses Associated with Participating in the Study

You will not have to pay for anything involved with this study. You will not be reimbursed for
transportation, meals, time, inconvenience, etc.

Conflict of Interest

All of these people have an interest in completing this study. Their interests should not
influence your decision to participate in this study. You should not feel pressured to join
this study.

Questions About the Study

If you have any questions, concerns or would like to speak to the study team for any
reason, please call: Principal Investigator, Dr. Vivian Huang at 416-586-4800 ext 2475

If you have any questions about your rights as a research participant or have concerns
about this study, call the Chair of the Mount Sinai Hospital Research Ethics Board
(REB) or the Research Ethics Office number at 416-586-4875. The REB is a group of
people who oversee the ethical conduct of research studies.These people are not part
of the study team. Everything that you discuss will be kept confidential.
Version Date:07/Jul/22
This study has been explained to me and any questions I had have been answered. I know that I may leave the study at any time. I agree to take part in this study as described above:

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