Disclosure Information

I am a co-author of an abstract being submitted to the 2024 Global Impact Conference. I hereby disclose the following relationships as the only relationships that I, my business associates, my family/spouse/relatives have had over the past 24 months that may be construed to create real or potential conflict of interest.

Have Disclosures Field Label:

There is a relationship that could represent or be perceived to represent a conflict of interest, I, therefore, authorize the disclosure of this existence in the program.

Disclosure Attestation Field Label:

I will not, without appropriate authorization, disclose to any third party any confidential information or document to which I obtain access by virtue of my service to FaithCare. This includes, but is not limited to, discussions or documents relating to strategies or plans, documents marked ‘confidential’, financial or marketing information, or unpublished data. If I have any reasonable doubt about whether particular information or a particular document is confidential, I will not make disclosure unless I have first clarified the situation with appropriate FaithCare leadership or staff and obtained authorization.

Author Disclosure Field Description:

FaithCare members and the general public place great trust in the work of the organization. Real or perceived undisclosed conflicts of interest may jeopardize that trust and FaithCare’s effectiveness. Conflicts of interest may also cloud the objectivity of decisions that FaithCare officers and volunteers make.

To minimize the potential impact of possible conflicts of interest, FaithCare has determined that all participants in FaithCare scientific activities must report all real or potential conflicts prior to the activity being developed and delivered to learners. All disclosure forms are reviewed by the Course/Program Directors for each activity. Course/Program Director disclosure forms are reviewed by FaithCare staff/leaders/volunteers. Most conflicts involve financial relationships with commercial interests. A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. These may include pharmaceutical companies, device manufacturers or distributors, service companies, or other for-profit entities. Relationships with commercial interests may affect how officers or volunteers view products or services. They may also prompt outsiders to assume bias even when none exists, harming the reputation and effectiveness of FaithCare.

Specific relationships with potential to create conflict of interest can include direct employment, management positions including directors and officers, royalties, consultants or board or advisory board positions, lecture fees paid by an entity (including membership on speakers bureaus or review panels), expert testimony especially to regulatory bodies or in litigation, ownership or beneficial ownership of stock or stock options, research funding, honoraria, gifts including travel or other in-kind payments (e.g., accommodations, sports tickets, appliances, electronic devices, etc.), intellectual property rights received or pending, and participation in sponsored research as a principal investigator. Contracted research funded by a commercial source also creates a potential conflict of interest; this includes research funding by which an employing institution receives a grant and manages funds and the CME provider serves as principal or named investigator on the grant. Investments made through diversified mutual funds or blind trusts in which the participant does not exercise decisional control excluded. Usually primary employment by a nonprofit or governmental organization does not create potential for conflict, but compensation to employers based on an individual’s work with a for-profit company may create bias that must be reported. Income from commercial entities unrelated to health care does not create a potential for conflict of interest.

By disclosing all relationships, participants and FaithCare allow others to judge the extent to which conflicts may have affected judgments in conscious or unconscious ways. If the potential for any relationship to create conflict of interest appears doubtful, then it should be disclosed.

Disclosure Confidentiality Field Label:

There is a relationship that could represent or be perceived to represent a conflict of interest, I, therefore, authorize the disclosure of this existence in the program.

Disclosure Copyright Field Label:

I understand that if any subject is discussed or presented to me for action that creates a conflict between any personal or other extra-organizational interests and my organizational responsibilities, I will not participate in the subject in any capacity, unless officially requested to do so.

I understand that all materials I develop shall be free of commercial bias and shall reflect best available evidence. I agree that no part of any presentation I may make in public contains individual identifying information or if Individual identifying information is included, I have obtained written consent for presentation.

I understand that this information will be held confidential by FaithCare, except that it may be released to the Board of Directors and the Ethics Committee. This information may be used by FaithCare to determine when potential conflict of interest appears sufficient to preclude participation in decision-making regarding commercial products or services.