We'd like to ask a few questions about you, so that we can be mindful of the diversity of the group and ensure we are hearing a broad range of perspectives. Please note that all the information that you provide here will be stored securely, not shared with anyone outside of the team, and deleted at the end of this project. To maintain your confidentiality, we will adhere to the Data Protection Act 2018 and Imperial College Healthcare NHS Trust data protection policies.
Which of our hospital(s) did they die in?*
If they spent time in more than one of these hospitals please state which hospitals
Which ward(s) did the person(s) important to you die within (if known)?
We are looking to speak to people at least three months after the death of the person important to them, so that they have had some time to grieve and start to process what has happened (this is in line with general research guidance). If it has been less time than that but you’d still like to get involved, please let us know.
How long ago did they die?*
Were you expecting your loved one to die? *
Please comment
About you Would you be happy to take part in the study?*
Do you consent to your details being stored safely by the study team for the duration of this project? To maintain your confidentiality, we will adhere to the Data Protection Act 2018 and Imperial College Healthcare NHS Trust data protection policies.*
What is your full name?*
What is your email address?*
What is your phone number?
Do you prefer to be contacted by email or phone?*
How did you hear about this opportunity?
Why do you want to be involved in this study?*
How old are you? (You must be over 18 to apply)*
What gender do you identify as?*
We are asking this to ensure that we are including a wide range of people throughout the study.
How would you describe your ethnicity?*
We are asking this to ensure that we are including a wide range of people throughout the study.
What is your religion, if any?*
We are asking this to ensure that we are including a wide range of people throughout the study.
Which languages do you feel comfortable speaking and are able to converse in?*
Do you have any accessibility needs, disability, or long-term health conditions?*
We are asking this to ensure that we are including a wide range of people throughout the study and to ensure that we make this study process accessible and inclusive for you.
Is there anything we can do to make this a more inclusive experience for you? Please let us know how we can support you in getting involved.
How would you like to speak with us for the one-hour interview? *
Ideally, we would love to speak with you via an online video call, but we want to make sure you feel as comfortable as possible. We are happy to instead speak to you over the phone, in person in a location of your choice, or by any other methods that you would prefer.
If you would like to provide a written response instead, please let us know.
Is there anything else you would like to tell us?
