Near-Death-Experience Research Survey
Survey by: Miss Rachel Langford, MSc. Med. Neuroscience
Email: Rachel.NDEuk@gmail.com
You are being invited to take part in a survey. Before you decide, you need to understand why the survey is being done and what it would involve for you.
Please take time to read the following information carefully.
• Part 1 tells you the purpose of this survey and what will happen if you take part
• Part 2 gives you more detailed information about the conduct of the survey.
Please do not hesitate to ask me (Rachel Langford – contact details above) if there is anything that is not clear or if you would like more information. Take time to decide whether or not you wish to take part.
Part 1
What is the purpose of the survey?
The purpose of this survey is to help in understanding the real life experiences of people who have had Near-Death-Experience (NDE). It is hoped that the information obtained will help to improve the care and support people who are recovering from cardiac arrest (CA), people under coma or different vegetative states, and to improve resuscitation.

Why have I been chosen?
I am inviting you to take part if you have had NDE. I am very interested to hear your story. The attached questionnaires have been established and assessed by researchers in the field and their purpose is to better understand your NDE and the way it affected your life.

Do I have to take part?
No. It is up to you to decide whether you wish to take part. If you decide to take part, you are still free to withdraw at any time, without giving any reasons. If you are part of the NDE UK support group, your decision to withdraw at any time, or decision not to take part, will not affect the standard of care that you receive from the group leader or members.

What will happen if I take part?
If you agree to take part, your participation will involve filling in two questionnaires. Some participants will be also chosen for a personal interview (about an hour) The interview will be electronically recorded using a small digital recorder or a smartphone. When I analyse what you have said or filled in on paper, all information will be anonymised; this means that it will be impossible to identify anybody taking part.

What do I have to do?
If you agree to participate in this survey, you will have to complete a consent form which is included below. The two questionnaires will follow the consent form. When you complete them, click 'send' at the bottom of the page and I will receive your answers. If chosen for an interview, I will contact you via email or phone to arrange a convenient time for you to meet. You can choose to participate in the survey but not in the interview, so you can always decide later about being interviewed.

Are there any risks?
No. The interview and/or the questionnaires should not present you with any risk and you are free to withdraw your consent at any time.

What are the possible benefits of taking part?
The benefit of your participation in this survey is that the information provided should help to improve the care and support provided to other people who are recovering from cardiac arrest (CA), people under coma or different vegetative states, and hopefully to improve resuscitation. Unfortunately, it may not directly benefit you.

What if there is a problem?
It is unlikely that something may go wrong during the interview or the completion of the questionnaires, however if this does happen, it will be dealt with immediately. Detailed information on this is given in Part 2.

Will my taking part in this survey be kept confidential?
Yes. All the information about your participation in this survey will be kept confidential. The details are included in Part 2.

What happens when the survey is finished?
If you wish, I will send you a summary of the findings when the survey finishes.

Part 2
Will my taking part in this survey be kept confidential?
All information collected in this survey will only be accessible by Miss Langford. All the information you provide will be treated confidentially. You will not be identified in any report or publication arising from this survey.

What will happen to the results of the research study?
When the survey is finished, Miss Langford will write a report of the findings as part of her interest in the field of NDE, and her plan to study its correlation with resuscitation for her PhD and future academic research. A summary of the findings will be available to participants when the survey is finished.

Who is organising and funding the survey?
The survey is my private idea and interest, and I plan to use it as part of my future research in this field. No organisation is currently funding this survey.

Who has reviewed the survey?
Both the questionnaires you will complete if you choose, are a well establish method in NDE research. They have been established and published by Professor Bruce Grayson and Professor Kenneth Ring. Bruce Greyson, M.D., is Carlson Professor of Psychiatry at the University of Virginia. Kenneth Ring, Ph.D., is Professor Emeritus of Psychology at the University of Connecticut. The NDE Scale was published in the Journal of Nervous and Mental Disease, 1983, and the Life Changes Inventory – Revised was published in the Journal of Near-Death-Experience Studies, 2004.

What if there is a problem?
As this is an interview and questionnaires survey, it is unlikely that anything could go wrong. However, if you have a concern about any aspect of this study, you should ask to speak with Miss Langford who will do her best to answer your questions. Please contact her in the first instance.

Consent
Please initial box
I confirm that I have read and understand the information sheet for the above survey. I have had an opportunity to consider the information, ask questions and have had these answered satisfactorily. *
Required
I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason and without my medical care or legal rights being affected. *
Required
I understand that the interview (if will take place) will be electronically recorded and that direct quotes may be used anonymously in papers, presentations and might be included in Miss Langford’s future academic/research publications. I agree to this. *
If relevant, you will be asked of you wish to be interviewed
Required
I agree to take part in the above survey and to be considered for an interview. *
Required
Please write your full name here *
This will not be published in any way. It is required in the consent part for ethics and admin purposes.
Your answer
Please write your full address here *
This will not be published in any way. It is required in the consent part for ethics and admin purposes.
Your answer
Please enter your Email here *
This will not be published in any way. It is required in the consent part for ethics and admin purposes.
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.