Thank you for agreeing to complete this survey. Your responses will help us better meet the needs of communities for information about how we live out the end of our lives.

Please give us honest feedback about your experience with the Finding Our Way series of articles.
 

1. Tell us about yourself

Age
Gender
Race/ethnicity
Do you work in healthcare? (Answer YES if you work in a healthcare setting, or if you are a healthcare professional.)
Does anyone in your family work in healthcare?
Have you cared for a terminally ill friend or family member?
Do you expect to care for a terminally ill friend or family member?
Have you been diagnosed with a life-threatening illness?

2. There are fifteen FOW articles. Please indicate how many of the articles you have read and how much you have read of each one.  (Choose One)

I have read all of the articles completely
I have read 5 or less of the articles completely
I have read 5 or less of the articles completely, and parts of some others
I have read between 6 and fifteen of the articles completely
I have read parts of all of the articles
I have read parts of 5 or less articles
I have read parts of between 6 and 15 of the articles

3. Where have you most often read the article(s)?

Local newspaper
Newspaper from outside my community
The internet
  Other:

4. Why did you choose to read the article(s) that you read? (Check all that apply)

Recognized the author
The topic was relevant to my personal life
I am interested in healthcare generally
I am interested in healthcare at the end of life
I always read everything in the newspaper
  Other

5. How well did the article(s) you read address questions or concerns you had about dying and care near the end of life?

6. Did the article(s) you read increase or decrease your confidence that you can and will receive the care that you want near the end of life?

Increased confidence
Decreased confidence
No effect

7. Were the article(s) accompanied by information on local resources for end of life care?

Yes

If yes, were they useful?

No

If no, did you wish there were local resources provided?

8. After reading the article(s) did you take any of the following actions? (Check all that apply.)

Thought about my preferences for end of life care
Talked with family or friends about my preferences for end of life care
Talked with my physician about my preferences for end of life care
Talked with a clergy person about my preferences for end of life care
Talked with a lawyer about my preferences for end of life care
Completed an advance directive form (a document that outlines your treatment preferences in case you are unable to communicate with the doctor)
Attended a public forum, discussion, or lecture on the topic
Looked for additional information on the Internet
Contacted local resources listed with the article(s)
Read a book or watched TV or a video on the topic
Other:

9. Which of the following statements best describes how you feel having read the article(s)?

I have never had a problem talking about these issues with family, friends, physicians, or clergy members
I feel more comfortable discussing these issues now (after reading the articles)
I am still uncomfortable talking about these issues


We will be conducting telephone discussion groups with selected consumers to learn more about perspectives on the Finding Our Way series.
 
If you are willing to be contacted about participating in such a group, please check this box and provide your contact information below.
NOTE: Your answers on the survey remain anonymous.
The contact information is stored separately from the survey information.

Name:
Address:
Daytime Telephone:
Evening Telephone:

If you want more information about local resources for end of life care, please check this box and provide your contact information above.
NOTE: Your answers on the survey remain anonymous.
The contact information is stored separately from the survey information.

Thank you for taking time to complete this survey!