Page 1: SNACC Survey Research Summary and Confirmation of Consent
This is the SNACC survey ('Symptoms and Nutrition After Critical Care').
Thank you for considering to participate in this survey.
We are interested in finding out whether patients who had been critically ill on a breathing machine (ventilator) in critical care*, have any after effects (symptoms) which can be linked with changes in their eating or weight, and whether they received or would have liked any nutrition advice.
*critical care units may be called 'intensive care units (ICU or ITU)' or 'high dependance units (HDU).
By you completing this survey, we will be able to help future patients better.
So, please take part in this survey if you are:
- 18years or older, and
- had been critically ill in a critical care unit* (ICU* or HDU*), and
- on a breathing machine (ventilator) through a throat tube or tight fitting mask for 3 days or more (ask a relative or critical care team if you are unsure)
However, please don't take part if you are:
- currently unable to eat or drink anything orally e.g. receiving nutrition only through a tube (nasogastric, percutaeous gastrostomy (PEG), nasojejunal or jejunostomy) or line into your veins (total parenteral nutrition (TPN))
Please see the 'Research Invitation and Information Sheet' for more information and contact the researcher, Louise Albrich, if you have any questions (details below).
This survey should take only 25-30 minutes of your time to complete and at the end you can enter into a £50 prize draw.
So, if you are happy to proceed, please confirm your consent below. If you have a hospital discharge letter, diary, or any details about your recent ICU stay (including dates) have this to hand, but do not worry if you dont have this. Also grab your list of medications (prescription). Take a moment to get this if you need to)
This survey will be open until 15 April 2018 at midnight.
Confirmation of Consent statements: (Please read these statements and then confirm your consent below)
1. I have read and understood the survey research information.
2. I have had the opportunity to contact the researcher to ask questions and where I had questions, these were answered satisfactorily.
3. I understand that my inclusion in this study is voluntary and that I am free to withdraw without reason at any time, by ending the survey completion, without my medical or legal rights being affected.
To confirm your consent please tick the box below:
If you have any questions or concerns please contact:
The researcher: Louise Albrich, Clinical Research Masters student and Dietetic practitioner
Email: email@example.com or Phone: 07557314013
Post: Clinical Research Unit (level 4), Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 4AT
The Chief Investigator: Mary Hickson, Professor of Dietetics, Plymouth University
Email: firstname.lastname@example.org or Phone: 01752 587542 or
If you have any concerns you need to raise with someone outside the research team, please contact:
The Yeovil Hospital Patient Experience Team on 01935 384706 or email@example.com
Where you received your 'SNACC survey invitation and information sheet' from? (select all those that apply)