Presentation Evaluation Survey

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The following questions ask for your honest feedback about our presentation entitled, "Ensuring That Health Care Wishes Are Respected and that Patients Receive Quality Care."

Your feedback helps us improve our programs. You can skip any questions you do not wish to answer. Thank you for your time.

I feel more knowledgeable about end of life topics:

Strongly Agree

Agree

Disagree

Strongly Disagree

Clear selection

I feel more confident about taking care of my (or my family’s) health at the end of life:

Strongly Agree

Agree

Disagree

Strongly Disagree

Clear selection

I will apply what I learned today:

Strongly Agree

Agree

Disagree

Strongly Disagree

Clear selection

Do you feel more comfortable talking to others about end of life planning?

Yes

Clear selection

After attending this program, I will: (check all that apply)

Talk with a loved one about the kind of end of life care I would want

Encourage family or friends to put their end of life wishes in writing

Decide who I want to make health care decisions for me if I’m unable to speak for myself

Inform patients about end of life planning, including completion of the health care proxy form

Raise awareness about the benefits of hospice and palliative care

None of the above

Other:

What did you like about the presentation?

How can the presentation be improved?

Any other thoughts or comments?

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