KMG Medical Group MO, P.C. Informed Consent for Telehealth Research
Last updated: March 18th, 2022
You are a patient who is either receiving or has expressed an interest in receiving Cognitive Behavioral Therapy (CBT) delivered through Cove’s migraine telemedicine platform. CBT is a form of psychotherapy that focuses on how a person’s thoughts, beliefs, and attitudes affect their feelings and behaviors. CBT is an effective treatment for migraine. CBT is administered through the Cove migraine telemedicine platform through eight audio and written modules.
Cove is conducting a study to determine whether CBT provided through telemedicine is successful. Cove would like to measure whether there is a change in headache severity and frequency, a change in headache-related disability, and change in behavioral health outcomes (anxiety, depression, resilience, and stress) after patients receive CBT through the Cove migraine telemedicine platform.
If you decide to participate in the study, you will complete a questionnaire before and after the study about your monthly headache severity and frequency, your headache-related disability, and your behavioral health outcomes.
In addition to information from your questionnaires, Cove will also use the information you provided when you enrolled with Cove. This includes your demographic information (age, sex, gender and race if provided), your description of your migraine characteristics and other medical and mental health problems you are experiencing, and your description of previous migraine-related treatment history.
Finally, Cove will evaluate information about the treatment you receive while enrolled in the CBT program, including your participation in the eight CBT modules and any medications prescribed. No information that identifies you will be released in any of the study results.
There will be no cost to you to participate in this study, but you will not receive any payment for taking part in the study.
This study is completely voluntary. Whether or not you decide to participate in the study, you will continue to receive your usual treatment or services provided by Cove or its affiliates, including CBT.
This study is conducted by Thirty Madison, d/b/a Cove. Please reach out email@example.com with any questions.