Clinical trial: NCT03998189
Section: Alternatives
Subsections: Are There Benefits To Taking Part In The Study?

You are not expected to receive any direct benefit from taking part in this research study. We hope the information learned from this study will benefit other people in the future.  
WHAT OTHER CHOICES ARE THERE?  
This is not a treatment study. Your alternative is to not participate in this study.  
WHAT ARE THE COSTS?  
There are no additional costs to you by participating in this study.  
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Clinical trial: NCT03998189
Section: Confidentiality
Subsections: Will Your Research Records Be Confidential?|What About My Health Information?

The results of this research study may be presented at scientific or medical meetings or published in scientific journals. Your identity and/or your personal health information will not be disclosed unless it is authorized by you, required by law, or necessary to protect the safety of yourself or others. There is always some risk that even de-identified information might be re-identified.  
Participant information may be provided to Federal and other regulatory agencies as required.  
The Food and Drug Administration (FDA), for example, may inspect research records and learn your identity if this study falls within its jurisdiction.

In this research study, any new information we collect from you and/or information we get from your medical records or other facilities about your health or behaviors is considered Protected Health Information. The information we will collect for this research study includes: medical history, smoking status, current medications, collection of your exhaled breath, saliva, blood, and urine, and the measurement of your tumor.  
If this research study involves the diagnosis or treatment of a medical condition, then Protected Health Information collected from you during this study will be placed in your medical record, and may be used to help treat you, arrange payment for your care, or assist with Medical Center operations.  
We will make every effort to keep your Protected Health Information private. We will store records of your Protected Health Information in a cabinet in a locked office or on a password protected computer.  
Your personal health information and information that identifies you ("your health information")
may be given to others during and after the study. This is for reasons such as to carry out the study, to determine the results of the study, to make sure the study is being done correctly, to provide required reports and to get approval for new products.  
Some of the people, agencies and businesses that may receive and use your health information are the research sponsor; representatives of the sponsor assisting with the research; investigators at other sites who are assisting with the research; central laboratories, reading centers or analysis centers; the Institutional Review Board; representatives of Wake Forest University Health Sciences and North Carolina Baptist Hospital; representatives from government agencies such as the Food and Drug Administration (FDA) or the Office of Human Research Protections (OHRP), the Department of Health and Human Services (DHHS) and similar agencies in other countries.  
Some of these people, agencies and businesses may further disclose your health information. If disclosed by them, your health information may no longer be covered by federal or state privacy regulations. Your health information may be disclosed if required by law. Your health information may be used to create information that does not directly identify you. This information may be used by other researchers. You will not be directly identified in any publication or presentation that may result from this study unless there are photographs or  
 recorded media which are identifiable.  
Monitors, auditors, IRB or other regulatory agencies will be granted direct access to the participant's original medical record for verification of clinical trial procedures or data, without violating confidentiality of the participant and to the extent permitted by other applicable laws.  
If required by law or court order, we might also have to share your Protected Health Information with a judge, law enforcement officer, government agencies, or others. If your Protected Health Information is shared with any of these groups it may no longer be protected by federal or state privacy rules.  
Any Protected Health Information collected from you in this study that is maintained in the research records will be kept for at least six years after the study is finished. At that time any research information not already in your medical record will either be destroyed or it will be deidentified. You will not be able to obtain a copy of your Protected Health Information in the research records until all activities in the study are completely finished.  
You can tell Andrew Bishop, PhD that you want to take away your permission to use and share your Protected Health Information at any time by sending a letter to this address:
Andrew Bishop, PhD, Assistant Professor Internal Medicine/ Molecular Medicine Wake Forest Baptist Health Medical Center Blvd Winston Salem, NC 27157 However, if you take away permission to use your Protected Health Information you will not be able to be in the study any longer. We will stop collecting any more information about you, but any information we have already collected can still be used for the purposes of the research study.  
By signing this form you give us permission to use your Protected Health Information for this study.  
If you choose to participate in this study, your medical record at Wake Forest University Baptist Medical Center will indicate that you are enrolled in a clinical trial. Information about the research and any medications or devices you are being given as a participant may also be included in your medical record. This part of the medical record will only be available to people who have authorized access to your medical record. If you are not a patient at this Medical Center, a medical record will be created for you anyway to ensure that this important information is available to doctors in case of an emergency.  
7 of 9 Laboratory test results and other clinically relevant medical reports created as a result of your  
  
participation in the research study may be entered into the computer systems of Wake Forest University Health Sciences and North Carolina Baptist Hospital. These will be kept secure, with access to this information limited to individuals with proper authority, but who may not be directly involved with this research study.  
A North Carolina Baptist Hospital (NCBH) medical record will be created for all study participants. Information about your participation in the study will be placed in the NCBH medical record, along with any routine medical test results that were obtained at NCBH as part of this study.
Clinical trial: NCT03998189
Section: Participant's Rights
Subsections: What Are My Rights As A Research Study Participant?

Taking part in this study is voluntary. You may choose not to take part or you may leave the study at any time. Refusing to participate or leaving the study will not result in any penalty or loss of benefits to which you are entitled. If you decide to stop participating in the study we encourage you to talk to the investigators or study staff first to learn about any potential health or safety consequences. The investigators also have the right to stop your participation in the study at any time. This could be because it is in your best medical interest, your condition worsened, new information becomes available, you had an unexpected reaction, you failed to follow instructions, or because the entire study has been stopped. Information that identifies you may be removed from the data or specimens that are collected as part of this study and could be used for future research or shared with others without additional consent.  
You will be given any new information we become aware of that would affect your willingness to continue to participate in the study.
Clinical trial: NCT03998189
Section: Possible Risks, Discomforts, and Inconveniences
Subsections: What Are The Risks Of The Study?|What Happens If You Experience An Injury Or Illness As A Result Of Participating In This Study?

Being in this study involves some risk to you. You should discuss the risk of being in this study with the study staff.  
You may experience discomfort, bruising and/or bleeding where the needle is inserted.  
Occasionally some people become dizzy lightheaded or feel faint. Infection may occur on rare occasions. Frequent donation of blood can result in low iron in your blood (iron deficient anemia).  
In addition, there is a slight risk of a breach of confidentiality. We will do our best to protect your confidential information. There also may be other risks that we cannot predict.  
The risk of harm or discomfort that may happen as a result of taking part in this research study is not expected to be more than in daily life or from routine physical or psychological examinations or tests. You should discuss the risk of being in this study with the study staff.  
Taking part in this research study may involve providing information that you consider confidential or private. Efforts, such as coding research records, keeping research records secure and allowing only authorized people to have access to research records, will be made to keep your information safe.

Should you experience a physical injury or illness as a direct result of your participation in this study, Wake Forest University School of Medicine maintains limited research insurance coverage for the usual and customary medical fees for reasonable and necessary treatment of such injuries or illnesses. To the extent research insurance coverage is available under this policy the reasonable costs of these necessary medical services will be paid, up to a maximum of $25,000. Wake Forest University Baptist Medical Center holds the insurance policy for this coverage. It provides a maximum of $25,000 coverage for each claim and is limited to a total of $250,000 for all claims in any one year. The Wake Forest University School of Medicine, and the North Carolina Baptist Hospitals, Incorporated do not assume responsibility to pay for these medical services or to provide any other compensation for such injury or illness. Additional information may be obtained from the Medical Center's Director of Risk and Insurance Management.  
If you are injured, the insurer may require information such as your name, social security number, and date of birth in order to pay for your care. This is because the insurer is required by law to report any payments made to cover the care of any persons who are members of a  
 government insurance plan to the Department of Health and Human Services.  
You do not give up any legal rights as a research participant by signing this consent form. For more information on medical treatment for research related injuries or to report a study related illness, adverse event, or injury you should call Andrew Bishop, PhD.
Clinical trial: NCT03998189
Section: Procedures
Subsections: What Is Involved In The Study?

If you take part in this study, you will have the following tests and procedures:
Today, following your meeting, we will be asked of your smoking status. We will collect two breath samples, a saliva sample, a urine sample, and an optional blood sample. This will take place in an adjacent examination room where we will also ask you a few brief dietary and tobacco use questions. Before your follow-up appointment, a staff member will call you with a reminder for the study collections at your 1 month follow up appointment. Four weeks after your surgery (during your follow-up appointment), you will be asked the same dietary and tobacco use questions and we will collect two breath samples, a saliva sample, a urine sample, and an optional blood sample.  
If you choose to provide a blood sample, you will have approximately two tablespoons of blood withdrawn from a vein today and after your surgery. The total amount of blood withdrawn during the study will be approximately four tablespoons.  
Agree to provide blood (Please Initial): Yes _________
No _________
You will have two breath tests performed to collect exhaled breath today and after your surgery.  
The first test will collect approximately 6 minutes of exhaled breath. You will be asked to breathe into a collection device which will be placed over your nose and mouth. The second collection will require you to breathe into a collection tube for 10 minutes.  
2 of 9 You will have approximately 5 teaspoons of urine collected today and after your surgery. The  
  
total amount of urine collected during the study will be approximately 10 teaspoons.  
You will have about half a teaspoon of saliva collected today and after your surgery. The total amount of saliva collected during the study will be about 1 teaspoon.  
STORAGE OF BIOLOGICAL SPECIMENS
In the future, research on your specimen may involve whole genome sequencing. Your sample will be obtained in the Comprehensive Cancer Center at Wake Forest University Baptist Medical Center. The sample will be stored at the Wake Forest Biotech Place research laboratory in Winston-Salem, NC and it will be given only to researchers approved by Andrew Bishop, PhD. An Institutional Review Board (IRB) must also approve any future research study using your samples. In order to participate in this study, you must be willing to provide these samples for future research.  
The research that may be performed with your blood, exhaled breath, urine, and saliva samples are not designed to help you specifically. There is no personal benefit to you from taking part in this aspect of the research study. It might help people who have diseases at some point in the future, but it is not known if this will happen. The results of the research performed with your blood, tissue, exhaled breath, urine, and saliva samples will not be given to you or your doctor. The results will not be put in your medical record. The research using your blood, tissue, exhaled breath, urine, and saliva samples will not affect your care.  
Your blood, tissue, exhaled breath, urine, and saliva samples will be used only for research and will not be sold. The findings from this research may result in the future development of products that are of commercial value. There are no plans to share any of the profits with you which may occur as a result of the research.  
Your blood, tissue, exhaled breath, urine, and saliva samples will be stored with a unique identifier and will not include any identifiable information about you such as your name, address, telephone number, social security number, medical record number or any of the identifiers outlined in the HIPAA Privacy Rule. The unique identifier will be a randomly assigned number and only the principal investigator will have access to the code that links the unique identifier to you. Your name, address, social security number, etc., will never be disclosed to future researchers and neither will the code that links your identifiers to the sample.  
In the future, people who do research may need to know more about your health. While the study investigator may give reports about your health, he/she will NOT be given your name, address, phone number, or any other identifying information about who you are, unless you agree to be contacted in the future.  
____YES you many contact for future research studies ____NO I do not want to be contacted regarding future research studies.  
  
HOW LONG WILL I BE IN THE STUDY?  
  
You will be in the study for about 5 weeks.  
You can stop participating at any time. If you decide to stop participating in the study we encourage you to talk to the investigators or study staff first.
Clinical trial: NCT03998189
Section: Purpose of Research
Subsections: Why Is This Study Being Done?

The purpose of this research study is to look at your non-invasive samples (breath, saliva, blood, and urine) for any changes before and after your surgery. These samples will help researchers find out if there are specific compounds in your samples that may identify lung cancer.  
HOW MANY PEOPLE WILL TAKE PART IN THE STUDY?  
90 people will take part in this study at Wake Forest Baptist Medical Center only.
Clinical trial: NCT03998189
Section: Voluntary Participation
Subsections: Will You Be Paid For Participating?

You will receive a prepaid cash card in the total of $50.00 for providing both pre- surgery and post-surgery collection time points.  
Parking validation will be provided for all study-related visits.