Withdrawal Information: Consultees – INVOLVE
This form documents that a consultee has advised that the participant should be withdrawn from the INVOLVE Research database. Completed forms should be forwarded to Future Genetics to allow for prompt removal of the subject in accordance to the received advice.
Overview of Withdrawal via a Personal Consultee
A consultee is a person who informs the research team whether it is appropriate for a person who cannot reliably tell us whether they should either take part or be withdrawn from the research database.
For purposes of this document we will refer to the person with reduced capacity as the “person” or “participant”.
A consultee will act on behalf of a participant who is either a relative, friend, or carer of the person. You should only act on their behalf if you can best understand their views and feelings about taking part or withdrawing, and if you are also acting in their interests only.
This document is for consultees to read and complete if they believe that the participant should be withdrawn from the INVOLVE research database. Please read through the full document before completing.
Please be aware and assured that withdrawal from the INVOLVE research database has no impact on the level of care received by the participant.
The participant can leave the Research database at any time, and as the consultee, you do not have to provide any reason for the decision to withdraw. Your advice will be acted upon.
Should you wish, you can discuss withdrawal with researchers who are based at the NHS site associated with the participant (i.e. their GP surgery or clinic).
Once researchers receive the completed form the participant will be removed from the research database as soon as possible.
The content of this form is similar to the Withdrawal form used by participants who can make their own decision to withdraw from the research database. A key difference is that this form addresses questions to you as the Consultee rather than directly to the participant.
In order to keep a record of the withdrawal you will be asked to complete a withdrawal form and return this to your GP or clinic doctor who is involved in this research database.
At the time of withdrawal, de-identified data may already have been used to carry out scientific and clinical research. It is not practical to discard research analyses that has already been carried out and then re-perform analyses in the absence of the withdrawing patient’s de-identified data. Therefore, withdrawal will only be applied to identifiable medical information and biological samples that have not been used in the research project.
The Withdrawal form will give you three choices:
- No new samples will be requested by researchers. Any existing identifiable samples will be destroyed when we receive the withdrawal form. Researchers will continue to update medical records by collecting and de-identifying new information in order to support ongoing research. We will no longer contact you (neither directly or indirectly via the NHS site team).
- New samples may be requested if needed for research, but medical records will not be updated. We will no longer contact you (neither directly or indirectly via the NHS site team), unless there is a need to collect a sample.
- No new samples or updates of medical information will be collected by researchers. We will no longer contact you (neither directly or indirectly via the NHS site team). Any identifiable clinical data or samples held by Future Genetics at the time of receiving the completed withdrawal form will be deleted or destroyed.
|Future Research Options||Collect New Sample||Collect updates of medical records|
✓ = collected for future research
x = not collected for future research
In order to keep a record that the participant had previously taken part and then withdrawn from the INVOLVE research database, we will need to keep a record of basic information. This minimal information would include yours (as the consultee) and the participant’s name, date of birth, and address. This is for auditing purposes and also to ensure that we do not contact you again.
Form for Withdrawal of a participant with reduced capacity
Completion of the below form confirms that you as the consultee have advised for the participant with reduced capacity to be withdrawn from the INVOLVE research database.
|Your Name as the personal consultee
Full Name (BLOCK CAPITALS)
|Name of Participant with reduced capacity
Full Name (BLOCK CAPITALS)
I confirm that I have read and understand the information related to withdrawal.
Based on the views, feelings, and interests of the participant, I as the consultee understand that the participant should be withdrawn from the INVOLVE Research database.
I, as the consultee, am aware that I have been able to ask any questions and discuss the withdrawal with NHS Doctors and Research staff that are involved in the research database (who work at the participating GP surgery/ NHS clinic).
My advice is that the participant is Withdrawn from the INVOLVE research based on the below selection:
|Options||Tick ONE area only|
|Option 1: No new samples collected, but medical records are updated|
|Option 2: New samples collected, but medical records not updated|
|Option 3: No new samples collected and medical records not updated|
By signing the below, I confirm that the participant should be withdrawn based on my advice, and I understand that my advice will be acted upon.
|Personal Consultee Name|
|Relationship to participant|
Once this form has been completed, the original form will be kept by the researchers. Copies will be given to the NHS site taking part in the research database (GP surgery or NHS clinic). You will also be given a copy of this completed form, either as a hard copy or sent to you via email.
Thank you for your support of this project. We also appreciate you informing us of your decision for withdrawing the participant from the research database.
The Research Team from the INVOLVE Research database.