Promoting Excellence : Family Satisfaction Assessment (Parts 1 and 2)

Children's Hospital: Family Satisfaction Assessment (Parts 1 and 2)

This interview assesses the experience of the patient and/or family with respect to end-of-life care.

Evaluation Tools - Satisfaction/Perception of Care

Children's Hospital and Regional Medical Center
Pediatric Palliative Care Project
Mail Stop CM - 11
4800 Sand Point Way, N.E.
Seattle, WA 98105

Beth McKinstry
[email protected]

How the grantee used this instrument:
Part I is self-administered by parent or guardian and/or patient with in-person assistance from Consultant at the pre-enrollment home visit. Parent and/or patient respond to telephone interview of Part II every three months.

pediatrics, family experience, family perception of care, patient experience, patient perception of care, patient satisfaction

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.

Developed specifically for this project by the project team.

Information/References on Validity and Reliability:
Using a five-point scale, Part I of this tool elicits the consumer's assessment of the quality of care received in the following domains: medical care, information, communication, partnership with providers, overall quality of care, and health plan quality. Part II of this tool uses consumer self-report to assess the impact of participating in the Pediatric Palliative Care Project - on the ability of the parent to manage patient pain and symptoms, the effective management of the patient's pain and symptom levels, and whether Project tools and material's improved the parents' ability to care for the child.

To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
pdf PDF 386 KB / 6 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted September 2003

# CHRMC3, type:satisfaction/perception_care

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

Promoting Excellence logo and link to home page