Promoting Excellence : Modified City of Hope Bereaved Questionnaire and CALL Care Cover Letter

Supportive Care of the Dying: Modified City of Hope Bereaved Questionnaire and CALL Care Cover Letter

Two questionnaires for the patient enrolled in the CALL Care program assessing experiences in the following areas: physical, emotional, spiritual, health care environment, health care providers, and personal information. Includes an introductory cover letter to the family.

Evaluation Tool - Satisfaction/Perception of Care

Supportive Care of the Dying: A Coalition for Compassionate Care
c/o Providence Health System
4805 NE Glisan Street,2E07
Portland, Oregon 97213
tel: (503) 215-5053
fax: (503) 215-5054

Sylvia McSkimming
e-mail: [email protected]

How the grantee used this instrument:
Used to gather information for assessment of the dying experience as experienced by the bereaved family. The first version is an in-depth survey, while the second version is shorter and covers essential questions only.

after death interview, caregiver survey, satisfaction survey

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.

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 88 KB / 12 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted October 2004

# SCD05, 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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