Self-Compassion Guidebook for Hospice Palliative Care Workers: Application
RequiredRequired Question(s)
Apply to participate in a research project on a 4-Week Workshop Series: "Self-Compassion Guidebook for Hospice Palliative Care Workers."

Week 1: Introduction to self-compassion
Week 2: Noticing
Week 3: Self-Kindness
Week 4: Common Humanity

Which session would you like to attend? 

May Court Hospice library. Tuesdays 3:15-3:45 from February 18-March 10
Ruddy Shenkman Hospice. Thursdays 2:30 from February 20--March 12
Ruddy Shenkman Hospice. Thursdays 3:15 from February 20--March 12
Roger NeIlson House Living Room. Wednesdays 12:00-12:30 February 12, 19, 26, and March 11
Basic information:

First Name:
Last Name:
Job Title:
Company Name:
Home Phone:
Email Address:

Informed Consent Form

Name and Contact Information of Researchers:
1) Pamela Grassau, Principal Investigator, Carleton University, Faculty of Public Affairs

2)  Tara Cohen, Co-Investigator, Program Manager, Champlain Hospice Palliative Care Program

3) Carl Schmidt, Co-Investigator, Program Coordinator, Champlain Hospice Palliative Care Program

4) Angela Gushue, Student Researcher, Carleton University, Faculty of Public Affairs

5) Olivia Keays, Student Researcher, Carleton University. Faculty of Public Affairs

6) Monica Ma, Student Researcher, Carleton University, Faculty of Public Affairs

7) Ngoc Han Nancy Do, Student Researcher, Carleton University, Faculty of Public Affairs
8) Meaghan Pinard, Student Researcher, Carleton University, Faculty of Public Affairs
Self-Compassion Guidebook for Hospice Palliative Care Team Members

Project Funder: The Champlain Hospice Palliative Care Program will fund the research project

You are invited to take part in a research project because you are a hospice palliative care team member. The information in this form is intended to help you understand what we are asking of you so that you can decide whether you agree to participate in this study. Your participation in this study is voluntary, and a decision not to participate will not be used against you in any way. As you read this form, and decide whether to participate, please ask all the questions you might have, take whatever time you need, and consult with others as you wish.
What is the purpose of the study?

Kristen Neff (2003) defines self-compassion as a key construct within the field of self-care that demonstrates relating to oneself with compassion by actively encouraging the expression of warmth, concern and caring toward the self. Existing research describes the ways in which the self-compassion of health care team members can benefit both the worker and the people they are caring for.
This research will explore if the Self-Compassion Guidebook, which was developed in response to a community program called 'Self-Compassion for Healthcare Providers,' and in subsequent workshops that took place over a period of two years, can increase self-compassion of team members working in hospice palliative care. Accordingly, the purpose of the study is to explore the question: Does the Self-Compassion Guidebook program increase self-compassion?
If the research shows that self-compassion is increased through this program, this could benefit the hospice palliative care sector as individual employees will experience increases in self-compassion. Self-compassion is linked to resiliency and an overall sense of well-being; clients of hospices and other program participants, in addition to paid team members, will benefit from an increase in self-compassion as it is linked to treating others more compassionately.
What will I be asked to do?

If you agree to take part in the study, we will ask you to:
  • Participate in four 20-30 minute sessions where information is shared about self-compassion and there is a chance to try out some self-compassion exercises.
  • Between each of the Self-Compassion sessions, think about the ideas and practice the exercises that were shared in the previous session(s).
  • Complete an evaluation form at the end of each session that is expected to take about 5 minutes.
  • After the four sessions, consider taking part in an interview that is expected to take about 30-45 minutes.
  • Complete Neff's Self-Compassion Scale to measure your level of self-compassion before, immediately after, and four months following the training sessions.
Risks and Inconveniences

A potential risk exists that, if subpoenaed, the researcher may be required to divulge the research results. As well, access to information associated with the research may be provided for professional auditing purposes. There are also a few circumstances where the researcher will be required to report to the necessary authorities. These circumstances include: 1) if a participant mentions experiences with abuse of someone under the age of 16 years old or of someone in long-term care by a health care professional; 2) if a participant mentions experiences with domestic violence, including physical and sexual abuse; or 3) if there is risk of harm, to the participant themselves or others, in any way.

Discussion about the topic of this study may be difficult for some, as it could bring up difficult emotions. If this occurs, you are free to ask for support or leave at any time, without explanation. A local Ottawa crisis phone line will be available to participants if they wish to seek out emotional support after or during the interview in addition to the support on site.
Possible Benefits
The direct benefits to research participants may be an increase in self-compassion, resilience, and a sense of well-being.
There will be refreshments at all sessions. A $50 gift card will be provided at the end of the four sessions for participants who have attended all four. An additional $20 gift card will be provided to participants who participate in the interview at the beginning of the interview and regardless of its duration.
No waiver of your rights
By signing this form, you are not waiving any rights or releasing the researchers from any liability.
Withdrawing from the study
You can choose to be or not to be in this study. If you are willing to be in this study, you may withdraw at any time without consequences of any kind. You may also refuse to answer any questions you don't want to answer and still remain in the study.

If you withdraw your consent during the course of the study, all information collected from you before your withdrawal will be discarded.

You may request that your data be removed from the study and deleted by notice given to the Principal Investigator (named above) at the end of any of the four sessions or within two weeks of your interview but not afterwards.

We will treat your personal information as confidential, although absolute privacy cannot be guaranteed. No information that discloses your identity will be released or published without your specific consent. Research records may be accessed by the Carleton University Research Ethics Board in order to ensure continuing ethics compliance. Every effort will be made to ensure confidentiality of any identifying information that is obtained in connection with this study.

Identifying information will be collected at registration and pseudonyms will be assigned instead of participant's names. Information collected will be in Constant Contact, the researcher's notes, and data management software. This data will be seen by only the above-named researchers and will be destroyed upon completion of the study. Hardcopy data will be secured in a locked filing cabinet within a locked office, computer data will be stored on a password protected computer.
Data Retention
Consent forms and anonymous sessional evaluations will be stored in a locked file cabinet where only the researchers have access. Prior to digital transcription, physical Self-compassion Scales will also be stored in a locked file cabinet where only the researchers have access. Electronic data (transcribed Self-Compassion Scores, audio recordings, and demographic/contact data) will be saved in a password protected and USB key, which will be stored in a locked cabinet in the Principal Investigator's office. The data will be shared only with the researchers. All personal identifiers will be deleted by June 2021 and then data will be destroyed. Participant contact information is kept on the platform "Constant Contact" where participants register for the sessions.
New information during the study
In the event that any changes could affect your decision to continue participating in this study, you will be promptly informed.

Ethics review
This project was reviewed and cleared by the Carleton University Research Ethics Board [A or B]. If you have any ethical concerns with the study, please contact Carleton University Research Ethics Board (by phone at 613-520-2600 [ext. 2517 for CUREB A] or by email at

Statement of consent 

I voluntarily agree to participate in this study

I agree to be audio recorded           
I agree to be contacted for follow up research   
Demographic Questionnaire
If you are comfortable, please respond to the following questions. Responding will provide better insight for our research.


What is your age?

18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65 years old or older
prefer not to answer


What gender do you identify as?

Prefer not to answer
What language do you speak? (Please mark more than one if applicable).
Prefer not to answer
Please specify your ethnicity. (Please mark more than one if applicable).
South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
Latin American
Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.)
West Asian (e.g., Iranian, Afghan, etc.)
Prefer not to answer
Where were you born?

Outside of Canada
Prefer not to answer
Do you identify as:

First Nations (North American Indian).
Inuk (Inuit)
Not applicable
Prefer not to answer
What is the highest level of education achieved?

did not complete high school
high school diploma
other trades certificate or diploma
college, CEGEP, other non-university certificate or diploma
university certificate or diploma below bachelor's level
bachelor's degree
degree in medicine, dentistry or optometry
master's degree
Prefer not to answer
What is your role in the hospice?

personal support worker
social worker
volunteer coordinator
How long have you been in your current role?


50 characters left.


How long have you worked in hospice palliative care?


50 characters left.
We will let you know as soon as possible if you are selected for the research project. Due to the space limitations we cannot accept all applications.