CART-WHEEL Online Consent Demonstration

Created: April 2017 by CART-WHEEL This document contains screenshots of all pages of the online consent module to give you a better feeling for what we are

asking and how the online consent module works.

Content: Start Page for Online Consent ........................................................................................................................... 2

Screen 1: Consent Form Type and Patient Details ........................................................................................... 3

Screen 2: Consent Start ..................................................................................................................................... 4

Screen 3: Section 1 – Your Consent .................................................................................................................. 5

Screen 4: Section 2 - Background ...................................................................................................................... 6

Screen 5: Section 3 – What is BioGrid Australia and The Rare Tumour Database .......................................... 7

Screen 6: Section 4 – What do you want from Me? ......................................................................................... 8

Screen 7: Consent Options ................................................................................................................................ 9

Screen 8: Consent Options Cont. .................................................................................................................... 10

Screen 9: Section 5 & 6 .................................................................................................................................... 11

Screen 10: Section 7 – For what purpose will my tissue be used? ................................................................ 12

Screen 11: Section 8 – What information will be on the Rare Tumour Database? ...................................... 13

Screen 12: Section 9 – How will my privacy be protected? ........................................................................... 14

Screen 13: Section 9 – Cont. ............................................................................................................................ 15

Screen 14: Section 10 - 13 ............................................................................................................................... 16

Screen 15: Section 14 – Participation is Voluntary ........................................................................................ 17

Screen 16: Section 15 – Ethical Guidelines ..................................................................................................... 18

Screen 17: Consent Selection .......................................................................................................................... 19

Screen 17.1: Clinician Details Entry* .............................................................................................................. 20

Screen 18: Participation in a Research Project other than CART-WHEEL...................................................... 21

Screen 19: Consent Summary ......................................................................................................................... 22

Start Page for Online Consent – Consent Completed .................................................................................... 23

Withdrawal of Consent Screen ....................................................................................................................... 24

Start Page for Online Consent – Consent Withdrawn .................................................................................... 25

Start Page for Online Consent – Consent in Progress .................................................................................... 26

Cancel Consent Screen (Consent in Progress) ................................................................................................ 27

Start Page for Online Consent

Screen 1: Consent Form Type and Patient Details

Screen 2: Consent Start

Screen 3: Section 1 – Your Consent

Screen 4: Section 2 - Background

Screen 5: Section 3 – What is BioGrid Australia and The Rare Tumour Database

Screen 6: Section 4 – What do you want from Me?

Screen 7: Consent Options

Screen 8: Consent Options Cont.

Screen 9: Section 5 & 6

Screen 10: Section 7 – For what purpose will my tissue be used?

Screen 11: Section 8 – What information will be on the Rare Tumour Database?

Screen 12: Section 9 – How will my privacy be protected?

Screen 13: Section 9 – Cont.

Screen 14: Section 10 - 13

Screen 15: Section 14 – Participation is Voluntary

Screen 16: Section 15 – Ethical Guidelines

Screen 17: Consent Selection

Screen 17.1: Clinician Details Entry*

*Entry screen will display if patient has given their clinician the consent to enter view or edit their data.

Screen 18: Participation in a Research Project other than CART-WHEEL

Screen 19: Consent Summary

Start Page for Online Consent – Consent Completed

Withdrawal of Consent Screen

Start Page for Online Consent – Consent Withdrawn

Start Page for Online Consent – Consent in Progress

Cancel Consent Screen (Consent in Progress)