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Vnd.openxmlformats Officedocument.wordprocessingml.document&Rendition=1

Uploaded by

Tara Pereira
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sri Siddhartha Medical College,

Agalakote, BH Road, Tumkur 572 107

IntitutionalEthics committee

Application for ethical approval


This form is intended for Sri Siddhartha Medical College faculty and students those joined for MBBS
and MD degree. It should be filled in after consulting the guide and supervisor and submitted for
approval to the Ethics committee coordinator.

You will notified within 2 weeks of submitting your application

Section A personal details

Name Tara Indira Delfino Pereira

Email address [email protected]

Degree Medical Student

Guide/supervisor Dr Ashwini M

Department Community Medicine

Date of submission 5/07/2024

Section B. Description of proposed research

B1. What is the current title?

Situational Analysis For Implementation Of Palliative Care At Health And


Wellness Centres

B2. Give a brief overall description of your research

A questionnaire based evaluation of the knowledge on palliative health care


and its implementation,pain management,dealing with psychosocial issues
amongst healthcare professionals at health and wellness centres and the
association of education and experience related variables

B3. Outline your main research questions and aims


To analyse the knowledge and implementation of palliative health care in
chronically ill patients in health and wellness centres

Section C. Participants Details

C1. What age groups will you be recruiting?

65 years and above

C2. Will you be recruiting any of the following?

1. Students
2. Hostel mates
3. Psychiatric disabilities
4. Friends or family
5. *Will not recruit from any of the above

C3. Explain briefly the no. of participants and method of recruiting

Section D. Proposed methodology and data collection

D1. Briefly explain the methodology

Data will be collected using a questionnaire based approach,which will be


distributed amongst healthcare workers in district health and wellness
centres

D2. What is the method of data collection

D3. Briefly explain the statistical methods


Section E. Risks and benefits

E1. Is there any likelihood of significant risk of harm to the rights and
wellbeing of participants?

No

E2. How might your research benefit participants?

This research will be submitted as part of icmr and will be available to all on
platform if accepted it will enlighten individuals and health officers on the
importance of palliative healthcare in the light increased painful deaths due
to chronic illnesses

Section F. Dissemination of results

F1. Will the results of your research be reported to participants?

If “yes”, please explain how you plan to do this.

Section G. further comments and Statement of undertaking

G1. Do you have any further comments or questions?

G2. Please accept the statement of undertaking before you submit the
application

• *I agree that I have read the ethical guidelines for human research

• *I agree to conduct this research in the manner advised

• *I agree to provide information regarding any change in the


methodology by informing the ethics committee and progress only
after approval
• *I agree to report any serious adverse event arising during the
research
• *I understand that I must wait for the ethics approval before
collecting the data from the participants

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