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Bereavement Survey - ESTH

We Value Your Feedback

Please accept our condolences for the loss of your loved one. At Epsom and St Helier University Hospitals NHS Trust we recognise the importance of monitoring the quality of care we give to our patients in the final phase of their life. If your loved one has died at our Trust and you feel ready to share your experience, please complete our Bereavement Survey here or using the paper form in your Bereavement Pack. The survey is completely voluntary and everything that you tell us is in confidence and anonymous, you are not required to provide any personal information. Your responses and your comments will be gathered with those of other people and used to help to improve the care that seriously ill patients and their families receive in our service and also to share good practice.

Dr Rebecca Suckling Site Chief Medical Officer and Theresa Matthews Site Chief Nursing Officer.

Bereavement Survey

We would greatly value your thoughts about the care your relative or friend received in the last days of their life. These will help us to ensure we provide the best possible care in the future. The following questions and statements relate to the care given to your relative or friend in the last days of life. How strongly do you agree/disagree with each of the following statements? Please select your answer and feel free to add any comments in the space provided.

End of Life Care and Support for you Relative or Friend

Strongly AgreeAgreeNeither Agree/ DisagreeDisagreeStrongly DisagreeDon’t know
1. Hospital staff ensured my relative/friend was comfortable during their last days of life (including pain or agitation)

1. Hospital staff ensured my relative/friend was comfortable during their last days of life (including pain or agitation)

2. Hospital staff gave my relative/friend the right level of emotional support.

Strongly AgreeAgreeNeither Agree/ DisagreeDisagreeStrongly DisagreeDon’t knowN/A
2. Hospital staff gave my relative/friend the right level of emotional support.

3. Hospital staff showed the right level of respect to my relative/friend including attention to their privacy and dignity.

Strongly AgreeAgreeNeither Agree/ DisagreeDisagreeStrongly DisagreeDon’t know
3. Hospital staff showed the right level of respect to my relative/friend including attention to their privacy and dignity.

4. Hospital staff gave my relative/friend the opportunity to talk to or access religious or spiritual support.

YesNoDon’t knowN/A
4. Hospital staff gave my relative/friend the opportunity to talk to or access religious or spiritual support.
5. Hospital staff gave my relative/friend the right support to eat or drink, if they wished or were able

5. Hospital staff gave my relative/friend the right support to eat or drink, if they wished or were able

6. Hospital staff gave your relative/friend regular oral and mouth care.

YesNoDon’t know
6. Hospital staff gave your relative/friend regular oral and mouth care.

7. Where in the hospital was your relative/friend cared for during the last days of their life?

Side RoomOn the Main WardEmergency departments
7. Where in the hospital was your relative/friend cared for during the last days of their life?

8. How would you rate the way in which hospital staff communicated with your relative/friend?

ExcellentVery GoodGoodFairPoorDon’t knowN/A
8. How would you rate the way in which hospital staff communicated with your relative/friend?

9. Overall, how would you rate the care and support given to your relative/friend by hospital staff during the last days of their life?

ExcellentVery GoodGoodFairPoorDon’t know
9. Overall, how would you rate the care and support given to your relative/friend by hospital staff during the last days of their life?

10. Please tell us why you have given this score?

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Support for you

Strongly AgreeAgreeNeither Agree/ DisagreeDisagreeStrongly DisagreeN/A
11. The healthcare team explained your relative/friend’s condition and/or treatment in a way that was easy to understand.
12. Hospital staff communicated sensitively and compassionately with me.
13. Hospital staff helped with my practical needs e.g. parking facilities, where I could access food.
14. Hospital staff contacted me soon enough to give me time to be with my relative/friend.

11. The healthcare team explained your relative/friend’s condition and/or treatment in a way that was easy to understand.

12. Hospital staff communicated sensitively and compassionately with me.

13. Hospital staff helped with my practical needs e.g. parking facilities, where I could access food.

14. Hospital staff contacted me soon enough to give me time to be with my relative/friend.

15. Please add any comments

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Bereavement Services and the Medical Examiner Office

Yes CompletelyYes to some extentNoN/A
16. If you visited the mortuary do you feel that you were treated sensitively and with compassion?

16. If you visited the mortuary do you feel that you were treated sensitively and with compassion?

17. Did you feel that staff in the Bereavement Office provided information and support regarding the completion of the necessary paperwork in a sensitive manner and gave you the opportunity to ask questions?

Yes completelyYes to some extentNoN/A
17. Did you feel that staff in the Bereavement Office provided information and support regarding the completion of the necessary paperwork in a sensitive manner and gave you the opportunity to ask questions?
18. Did you feel that staff in the Medical Examiner office, who contacted you to provide information surrounding the cause of death and next steps, spoke to you sensitively and gave you the opportunity to ask questions?

18. Did you feel that staff in the Medical Examiner office, who contacted you to provide information surrounding the cause of death and next steps, spoke to you sensitively and gave you the opportunity to ask questions?

19. Did you experience any unexpected delays in receiving the Medical Certificate of Cause of Death?

YesNoN/A
19. Did you experience any unexpected delays in receiving the Medical Certificate of Cause of Death?

20. Overall how would you rate your experience of Bereavement Services?

ExcellentVery GoodGoodFairPoorN/A
20. Overall how would you rate your experience of Bereavement Services?
21. Overall how would you rate your experience of the Medical Examiner Office?

21. Overall how would you rate your experience of the Medical Examiner Office?

22. What other comments about your relative/friend's end of life care would you like to make?

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WhiteWhite IrishAny other white backgroundIndianPakistaniBangladeshiAny other Asian backgroundBlack CaribbeanBlack AfricanAny other black backgroundChineseWhite and black CaribbeanWhitie and black AfricanWhite and AsianAny other mixed backgroundOtherDo not wish to disclose
23. Thinking about your loved one, what do you consider was their ethnic background?

23. Thinking about your loved one, what do you consider was their ethnic background?

24. Thinking about your loved one, what was their religion, if any?

BuddhistChristianHinduJewishMuslimSikhAny other belief/religionNo religionDo not wish to disclose
24. Thinking about your loved one, what was their religion, if any?

25. Which hospital and ward was your relative/friend on when they died?

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26. How long was your relative/friend in hospital before they died?

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