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
University of California, Davis
West Coast Center for Palliative Education
3630 Business Drive
Sacramento, CA 95820-2100
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 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 PromotingExcellence.org for more resources.