Name:
Supportive Care of the Dying: Modified City of Hope Bereaved Questionnaire
and CALL Care Cover Letter
Description:
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.
Category:
Evaluation Tool - Satisfaction/Perception of Care
Source:
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
www.careofdying.org
Contact:
Sylvia McSkimming
e-mail: Sylvia.McSkimming@providence.org
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.
Keywords:
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.
References:
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 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 PromotingExcellence.org for more resources.
