Promoting Excellence : Family Member Interview After Death Instrument for Simultaneous Case Study

University of California - Davis: Family Member Interview After Death Instrument for Simultaneous Case Study

A three-page, post-death, phone questionnaire for caregivers regarding the patient's health and medical care during illness.

Evaluation Tool - Satisfaction/Perception of Care

UC Davis Medical Center
2315 Stockton Blvd.
Sacramento CA 95817

Joan Blais MPA
Program Administrator
University of California, Davis
West Coast Center for Palliative Education
3630 Business Drive
Sacramento, CA 95820-2100
[email protected]

How the grantee used this instrument:
Used by the care team to assess the experience of the patient and/or family with respect to end-of-life care.

quality assurance, satisfaction, post death survey, caregiver survey, family perception of care, satisfaction survey

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.

Modified from the Toolkit of Instruments to Measure End-of-Life

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

Posted September 2004

UC Davis Medical Center overview page

# UCD2, 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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