Referral Practices to Otolaryngology (ENT) Specialists in Canada

Participant Consent Form

You are invited to participate in a research study entitled: Referral Practices to Otolaryngology (ENT) Specialists in Canada
Student Researchers: Ayeh Aldulaymi, undergraduate student, College of Medicine, University of Saskatchewan, aya442@usask.ca, Abdullah Qureshi, undergraduate student, College of Medicine, University of Saskatchewan, muq282@usask.ca, Sonya Mannala, undergraduate student, College of Medicine, University of Saskatchewan, uye987@usask.ca
Principal Investigator/Supervisor: Dr. Rick Jaggi, Associate Professor, Department of Otolaryngology – Head & Neck Surgery, College of Medicine, University of Saskatchewan, rij991@usask.ca

Purpose and Objective of the Research:
This study aims to better understand how healthcare providers across Canada refer patients to Otolaryngology (ENT) specialists. We are particularly interested in the consistency, accessibility, and clarity of referral pathways, as well as any barriers that may exist. Findings from this study may help inform future policy, education, or system improvements.

Procedures:
You will be asked to complete a brief online survey consisting of multiple choice and short answer questions. The survey will take approximately 5–7 minutes to complete. Participation is voluntary, and you may skip any question you do not wish to answer. Inclusion Criteria: Participants must be licensed healthcare professionals in Canada who are involved in the referral of patients to ENT specialists.

Potential Risks:
There are no known or anticipated risks to you by participating in this research.

Potential Benefits:
There may be no direct benefit to you for participating. However, your responses may help improve understanding of ENT referral practices and contribute to health system improvements and education for referring professionals.

Confidentiality:
This survey is hosted by SurveyMonkey. Your responses will be anonymous, and no personally identifying information will be collected. Data will be reported in aggregate form in presentations and publications so that individual responses cannot be linked back to you.
SurveyMonkey stores data on secure servers. For more information, see their privacy policy: https://www.surveymonkey.com/mp/legal/privacy

Storage of Data:
Electronic data will be stored securely on a password-protected University of Saskatchewan server (OneDrive) accessible only to the research team. All data will be retained for a minimum of five years following publication, after which it will be permanently deleted. No identifying information will be collected or stored. Dr. Rick Jaggi (Principal Investigator) will be responsible for the storage and safeguarding of all data collected.

Right to Withdraw:
Your participation is completely voluntary. You may choose not to participate or close the survey at any time before submitting. Since responses are anonymous, once you submit the survey, your data cannot be withdrawn as there is no way to identify which responses belong to you.

Follow Up:
If you would like a summary of the results of this study once available, you may email the research team at aya442@usask.ca. We anticipate that findings will be available within 6 months after your participation.

Questions or Concerns:
Contact the researcher(s) using the information at the top of page 1.
This research project has been approved on ethical grounds by the University of Saskatchewan Behavioural Research Ethics Board. Any questions regarding your rights as a participant may be addressed to that committee through the Research Ethics Office: ethics.office@usask.ca; 306-966-2975; out-of-town participants may call toll free 1-888-966-2975.

By completing and submitting this questionnaire, your free and informed consent is implied and indicates that you understand the above conditions of participation in this study.

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* 1. What is your professional designation?

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* 2. In which province or territory do you primarily practice?

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* 3. Are you able to refer patients directly to an ENT specialist?

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* 4. Do you have a billing code?

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* 5. In the absence of a formal referral pathway, do you rely on personal relationships or informal networks to make patient referrals?

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* 6. If you can refer patients directly to an ENT specialist, which conditions do you typically refer for? (Select all that apply)

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* 7. How often do you refer patients to an ENT specialist?

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* 8. What are the main barriers you face when referring patients to an ENT specialist?

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* 9. How would you rate the overall accessibility of ENT services for your patients?

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* 10. In your opinion, how could the referral process to ENT specialists be improved?

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* 11. Do you believe that allowing audiologists, SLPs, dentists, and dental specialists to refer directly to ENT specialists would improve patient care?

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* 12. Do you have any other comments?

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