The IPDAS Declaration of Interest Form is used to manage conflicts, promote transparency,
and adopt unbiased decisions that are in the best interest of the collaboration. Effectively
managing interests – and identifying potential conflicts – is essential if policy makers,
healthcare professionals, and the patients/public, are to maintain confidence in our work.
Why Must I File?

The information you provide on this form will be used to assess if you haveany potential conflicts of interest. Information will be disclosed on the IPDAS
website in the interest of transparency.

Who must complete it? Members of the IPDAS Steering Committee and members of special IPDAS
working groups.
When Must I File?

The report is due prior to assuming a position and updated yearly.

Reporting Period?

Report the required information for the 3 years preceding the date you complete
this form.

Questions(?)

If you have any questions about how to complete this form, please contact
ipdas@ohri.ca

What are the different types of interest?
Direct Interests:
When there is, or could be perceived to be, an opportunity for a person involved
with IPDAS work to benefit. This benefit could be financial or non-financial. Nonfinancial is described as increasing or maintaining their professional reputation(e.g., advocate for a particular group, holds office of authority in professionalorganization, actively involved in an ongoing research project aimed atdetermining the effectiveness of a matter under consideration; published a clear
opinion about the matter under consideration).
Indirect Interests:
When there is, or could be perceived to be, an opportunity for a third party
closely associated with the person in question to benefit. This could be througha close association with another person or organization that has a financial ornon-financial interest (defined above) and could benefit from a decision theperson is involved in making through their work on an IPDAS committee.
What are the responses to declared interests?
a. No action other than the process of open declaration.
b. Partial exclusion from developing recommendations and decision-making on the matter
relating to the interest – may provide advice because of their expert knowledge;c. Complete exclusion from having input to a specific topic.

Name/ email Rachel Thompson rachel.thompson@sydney.edu.au
Position/Title Senior Research Fellow
Employer

The University of Sydney

Country

Reporting Status
NewAustralia

Date of Completion (mm/dd/yy) December 10, 2018
RenewalFor each statement below, check Yes or No to describe your situation in the last 3 years or next
12 months.
I. I have reportable assets or sources of income for myself, my spouse, or my dependent children(research support, grants, scholarships, awards, consulting fees, royalties, patients).
II. I have reportable liabilities (debts) for myself, my spouse, or my dependent children.

YesNo

X

III. I have a reportable outside position(s) for myself.
IV. I have reportable agreements or arrangements for myself.
V. I have reportable gifts or travel reimbursements for myself, my spouse, or my dependent children.

XX
X
X

If you selected Yes for any statement, you must describe the reportable interests that you have below
Type of interest

Description of interest

Dateinterest
began

Dateinterest
ceasedComments/explanation (for IPDAS)

Intellectualproperty

I own copyright in written works including
several patient decision aids.

2015

Ongoing

I have not received any personal income
connected to this copyright ownership.

Authorship

I was an editor of the text, 'Shared
Decision Making in Health Care' (OxfordUniversity Press).

2016

Ongoing

I have not received royalties connected tothis role but may in the future.

Grants andfunding

I have been awarded (via my institutions)grants, funding, and donations forresearch in areas including shareddecision-making and patient decision
aids.

2015

Ongoing

Further information on sources of funding isavailable atwww.rachelthompson.org/disclosures.html.

Academicinterest

I have an academic interest and active,
ongoing research in the topic of decision
aids and conflicts of interest.

2017

Ongoing

I certify that the statements I have made on this form are true, complete, and correct to the best of my knowledge. I do/ do not [delete as applicable] give my consent for this information to be published on the IPDAS website.
Date of Completion (mm/dd/yy) December 10, 2018
Signature
FOR INTERNAL REVIEWERS’ USE ONLY:
Signature and Title of IPDAS Reviewer

E-mail Address
Comments of Reviewer

Approved by the IPDAS Steering Committee: August 2018

Date (mm/dd/yy)