Name:
Supportive Care of the Dying: Modified City of Hope Professional Questionnaire
and Cover Letter
Description:
An in depth questionnaire for professionals caring for the patient assessing
the experiences of the professional in the following areas: Personal/Professional
Experiences, Health Care Environment, Effectiveness of Care, Emotional, Spiritual,
and Personal Information. Includes an introductory cover letter to the physician
or other professional.
Category:
Clinical Care Tools - Clinical Assessment
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 professional caregiver.
Keywords:
care plan, provider assessment, psychosocial, well-being
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 1.84 MB / 10 pages (Viewing PDF files requires
downloading and installation of the free Adobe
Acrobat Reader.)
Posted October 2004
# SCD06, type:clinical_assessment
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.
