CAPC Palliative Care Discussion Forum
Data Collection and Measurement
This is the one we use. it did not cut and paste well in this format. I could email it as an attachment if that would help.
John Morris
PALLIATIVE CARE SATISFACTION SURVEY
The Palliative Care Team provides care to patients and families dealing with illness. Your honest feedback to this survey will help assess and improve our program.
Please answer the questions below about the care we provided to you or your family member. A self addressed, stamped envelope has been provided for your response.
Strongly Agree Agree Disagree Strongly Disagree N/A
1.A clear explanation of Palliative Care services was given.
2.We addressed pain and other symptoms causing discomfort.
3.We showed respect for your wishes and goals of care.
4.We helped ease stress or fears caused by the illness.
5.I would recommend Palliative Care services to others.
Please add any comments that may improve our care.
_________________________
Name (Optional)______________
If you would like to speak with someone about our program or care received, I welcome your call. Thank you for taking the time to complete our survey.
Sincerely,
Dr. John Morris
Medical Director of Palliative Care Services
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Re:Pt Sat Surveys