Promoting Excellence : Family / Surrogate Satisfaction Survey

Balm of Gilead: Family / Surrogate Satisfaction Survey

This quality of care survey is given to families of patients after the patient has died.

Evaluation Tools - Satisfaction/Perception of Care

Cooper Green Hospital
The Balm of Gilead Center
1515 Sixth Avenue South
Birmingham, AL 35233

Marc Sussman
[email protected]

How the grantee used this instrument:
This survey was given to the families of patients who died while receiving home hospice or inpatient palliative care. The survey was administered by phone 30 days after patient died.

after death interview, family experience, family perception of care, post death interview

To use this tool:
You may print and copy this tool for your own use from this site. We recommend that you consult the references before using this tool. Please credit source.

Beck-Friis B., Stang P. The family in hospital-based home care with special reference to terminally ill cancer patients. J. Palliative Care 1993:9:5-13.
Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Affairs Winter 1991;254-267.
Dawson, NJ. Need satisfaction in terminal care settings. Soc. Sci. Med. 1991;36:693-701.
National Hospice and Palliative Care Organization.
Ever get satisfaction? Institute of Medicine Conference: Evaluating Health Outcomes for Elderly People in a Changing Health Care Marketplace, Briefing Book, 1996./ul

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 118 KB / 3 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted April 2004

Cooper Green Hospital overview page

# BOG12, 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.

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