Name:
Mt. Sinai School of Health/Franklin Health, Inc. Communication Instrument
Description:
A one-page questionnaire with yes/no response for patients to evaluate
their interest in end-of-life care.
Category:
Evaluation Tool - Satisfaction/Perception of Care
Source:
Mount Sinai School of Medicine/ Franklin Health, Inc.
Mount Sinai Medical Center
Box 1070
One Gustav L. Levy Place
New York, New York 10029-6574
www.mountsinai.org
Contact:
Suzy Goldhirsch
suzy.goldhirsch@mssm.edu
How the grantee used this instrument:
Used to assess the patient's interest in discussing end-of-life care with their
family and physicians, and in appointing a health care agent.
Keywords:
patient experience
To use this tool:
You may print and copy this tool for your own use from the website. Please credit
source.
References:
Developed specifically for this project by the Franklin Health 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 14 KB / 1 page (Viewing PDF files requires
downloading and installation of the free Adobe
Acrobat Reader.)
Posted September 2004
# MS12, type:satisfaction/perception_of_care
Promoting Excellence in End-of-Life Care is 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.
