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Our PPIE Contributor Network brings together people affected by sepsis who would like to use their experiences to help shape research, improve healthcare and influence the services that support people affected by sepsis.

By joining the network, you may be invited to contribute to research studies and healthcare improvement projects that match your experience.

Research opportunities will vary depending on the needs of researchers and the projects we are supporting. As a result, invitations may be occasional and some contributors may be invited more frequently than others.

The UK Sepsis Trust cannot guarantee that every contributor will be invited to participate in a research project or other PPIE opportunity. Invitations will depend on the requirements of each project and how closely your experience matches those requirements.

Joining the network does not commit you to taking part in any project. You are free to decide whether or not to participate each time you receive an invitation.

Your details

First name

Last name

Email address

Phone number

Pronouns

First line of your address

Town or city

Postcode

Region

Date of birth (DD/MM/YYYY)

Contact preferences

Preferred method of contact

EmailPhoneEither

Are you happy for us to leave you a voicemail if we are unable to reach you?

YesNo

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Your experience of sepsis

Which of the following best describes your experience?

I have experience of sepsis because I, or someone close to me, experienced and survived sepsis. I have experience of sepsis through bereavement.

Who experienced sepsis?

Myself My child My partner or spouse My parent Another relativeSomeone I cared forOther

Who experienced sepsis?

My child My partner or spouse My parent Another relativeSomeone I cared forOther

Please specify

About the person who experienced sepsis

The following questions relate to the person who experienced sepsis (this may be yourself or someone else).

Year of birth

Year sepsis occured

Some research studies have eligibility criteria based on sex assigned at birth. Please select the option that best applies. If you would prefer not to disclose this information, select "Prefer not to say".

Sex assigned at birth

Female Male Intersex Prefer not to say

Ethnicity

Asian, Asian British or Asian WelshBlack, Black British, Black Welsh, Caribbean or African Mixed or Multiple ethnic groupsWhite: English, Welsh, Scottish, Northern Irish or BritishWhite: IrishWhite: Gypsy or Irish Traveller, Roma or Other WhiteOther ethnic groupPrefer not to say

If known, what was the source of the infection? Please select all that apply.

PneumoniaUrinary tract infection (UTI) Abdominal infection Skin or soft tissue infection Meningitis COVID-19 Influenza Pregnancy or birth-related Surgical complication OtherUnsure Prefer not to say

Please specify

Which of the following healthcare settings or treatments were involved in your / their care? Please select all that apply.

Contacted or assessed by a GP Ambulance / Paramedic care Attended an Emergency Department (A&E) Hospital admission Intensive Care Unit (ICU) High Dependency Unit (HDU) Mechanical ventilation Dialysis Surgery Unsure Prefer not to say

Does the person who experienced sepsis continue to experience any of the following? Please select all that apply.

Post Sepsis Syndrome Ongoing fatigue Cognitive or memory difficulties Mental health impacts Organ damage Ongoing physical disability Amputation Other long-term effectsNone of the above Unsure Prefer not to say

Please specify

Is there anything else about the sepsis experience that you feel would help us identify suitable PPIE opportunities for you?

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Reasonable adjustments

We are committed to making participation as accessible as possible.

A reasonable adjustment is a change or support that helps remove barriers to participation. This could include receiving information in advance, providing documents in an accessible format, allowing additional breaks, offering online meetings, or making other adjustments to support your participation.

Would you require any reasonable adjustments if invited to participate in a PPIE opportunity?

YesNoI'm not sure and would like to discuss this

Please tell us about any reasonable adjustments that would help you participate.

If you are invited to participate in a project, do you consent to the UK Sepsis Trust sharing details of your reasonable adjustments with the relevant research team where necessary to support your participation?

YesNoI'm not sure and would like to discuss this

We will only share information about the reasonable adjustments required to support your participation. We will not routinely share information about the underlying reason for those adjustments unless you ask us to, or it is necessary to support your participation.

Keeping in touch

By joining the UK Sepsis Trust's Patient and Public Involvement and Engagement (PPIE) Contributor Network, you may be contacted about PPIE opportunities that match your experience.

Other UK Sepsis Trust Updates

Would you also like to receive updates from the UK Sepsis Trust about our work, including volunteering opportunities, fundraising, local events and our newsletter?

YesNo

Consent

I understand this is an expression of interest to join the UK Sepsis Trust's Patient and Public Involvement and Engagement (PPIE) Contributor Network.

I understand that the UK Sepsis Trust will use the information I have provided to identify and contact me about relevant PPIE opportunities.

I understand that joining the network does not guarantee that I will be invited to participate in research projects or other PPIE opportunities. Invitations will depend on the needs of individual projects and how closely my experience matches the project requirements.

I understand I can withdraw from the PPIE Contributor Network at any time by contacting the UK Sepsis Trust.

I consent to the UK Sepsis Trust storing and using my information to manage my membership of the PPIE Contributor Network and to contact me about relevant PPIE opportunities in accordance with the UK Sepsis Trust Privacy Policy.

How did you hear about this programme?

How did you hear about this programme?

The UK Sepsis Trust website Social media Word of mouth Another organisation or groupOther

If other, please specify