Consent Form
Patient and Caregiver Stories for Change
Background information.
The Community Engagement (CE) Team supports members of the public to provide feedback and help
shape health care services within Vancouver Coastal Health (VCH) (for more information visit
cean.vch.ca). The CE Team is providing a new way for patients and caregivers to participate in quality
improvement through Patient and Caregiver Stories for Change. This initiative will collect patient and
family caregiver stories about the experience of receiving health care services within VCH. These stories
will be used to help staff understand what it is like to receive care and help staff to learn what we are doing
well and what could be changed in order to improve patient and family experiences. Stories may be
submitted by patients or caregivers (anyone who provides support to a close friend or family member) of
people who have received care within VCH.
The goal of this initiative is to build a library of patient and caregiver stories. These stories may be
posted anonymously on the Community Engagement Advisory Network Website (cean.vch.ca). Staff within
VCH will be able to search the story library and find stories that can be used for a variety of purposes, such
as education, or quality improvement. For example, stories may be used to educate new nurses on how
to provide patient-centered care. This will allow the patient voice to be included in decision making.
Your participation is voluntary.
Your participation is voluntary. You have the right to refuse to participate. If you decide to share your
story, you may choose to withdraw your story at any time by contacting the CE Team. As the story may
have been posted publically on the CE Website, we are not able to guarantee that the story has not been
used elsewhere, but we can take it off of the website and delete it from our computers.
What happens if you decide to participate?
If you decide to participate, we will give you a template that will help guide you to write a short story that
is less than 500 words. You can take as much time as you need to complete your story. When you are
done, you can submit the template to the CE Team by email to ce@vch.ca. If you require a paper copy of
the template, you can contact Belinda Boyd or Saori Yamamoto to receive a copy by mail (with return
postage).
Your story will not be edited, but names may be removed or changed to protect privacy. Your story may
be posted anonymously on the CE Website and/or shared with staff within VCH. Your story and contact
information will be stored on the CE Team database within VCH.
Are there any risks involved with participating?
While your story will be anonymous, certain details in your story may be identifiable. Receiving health
care services can be a personal experience, please consider what you are comfortable sharing publicly. If
you are a family member or caregiver, consider how your loved one would feel about you sharing
their personal information. It is best to ask for their permission first before submitting your story to
VCH. Writing your story may be upsetting if you and your family have had a negative experience. Please
let the CE Team know if you have any concerns.
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