End-of-Life Care Communication Survey
Share your experiences and feedback about communication during end-of-life care.
What is your role in relation to the end-of-life care experience?
*
Patient
Family member or loved one
Healthcare provider
Other
How would you rate the overall quality of communication you received regarding end-of-life care?
*
1
2
3
4
5
Did you feel that information about end-of-life care options was provided in a clear and understandable way?
*
Yes, completely clear
Somewhat clear
Not clear
Were your questions and concerns addressed respectfully by the care team?
*
Always
Usually
Sometimes
Never
How satisfied are you with the support provided during end-of-life care discussions?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Please share any additional comments or suggestions about communication during end-of-life care.
Submit Survey
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