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
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 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.