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 5. Whal is the purpose of this research study?

 You are being asked if you are inicrcscdj in p.aicip.liing in this study because you are
 scheduled forjoin replacement ,urer Tins srudy i b ing do~ to scc if there is a
 rcliaionship bctwcn your spiritual beliefs ain your: ellc evaluation and your need for pain
 medicine. Tie purpose ofthis sludy is to measure the amount oCpain medication you use for
 the first tree days Ailr your surgery.


6. What will be done if you take par in this research study?

 You will be asked to puriAipaic in Ihs study allcr you have been scheduled with Dr. Gc;rc~i.
 Dr. Myers, or Dr. Vlasak for hip or kne replaccaernt surgery. Through your participation in
 ihis study you will be asked to complcle two survey questionnaires. These survey
 qliisl;onnoircs will Inta uipron\ila[cI 20 minutes to complex,. You do not have to answer
 all of the questions if you do not wanl I ans.cr all The purpose oflthis sludy is Io explore
 reltioinships between spiritual dclicf1, spirilital involvement, a personal hall evaluation
 and the amount of pain nudicariin use aRlr joinil rcplacmoncl surgery. Your medical record
 will be cxainned for three days after surgery to determine the amount of pain you report after
 surgery and the amount of pain medication you use. Other information examined from your
 medical record will include your age. sex, diagnosis, location ofjoint eplaoen nl atnd
 ansllhesia given to you during yo surgery. ThS Principal Invcstigator will code all of yrur
 information wilh confidential code numbers. All ofyour daa will kepl in a locked secure
 file.

 All o your care will be normal procedures that re part of thc treatment for all patients
 having, lotal joint replacement surgery. There will be n iliu n uiiccrin your Irealmcnl while
 you ire part IrFlh; s.1mily


7. What are the possible discomforts and risks?

 Ilcre w ill be no po:sibli ri.l,. for you as a pw;ric;pinl in ihis study. You nmayexperince
 discomfort in answering qiuJerionr rc~grdi;ng your spiritualiy.

 Throughout the study, the rzcserclier %..i]l IdcIul'y yu of ew informaltion that may bcornue
 available that may ufacct your decision to remain in the study.

 iryou wish to discuss Ihe information above or any discomforts you may experience, you may
 ask questions now or call he Principal [nvesigatror contact person listed on the front page of
 this form.


8a. What are the pouiblre lirnerli tn ou?

 There are no bencils to you as part ofthis study.


259-2003D Rev 01,27-04 /pTa ",c- 'i