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  • Section A: Overall experience

  • 1. How Likely are you to recommend our hospice services to others who may need similar care?
  • 2. Overall, how satisfied are you with the care and support provided by our hospice?

  • Section B: Access to hospice services

  • 5. How easy was it to access our hospice services when they were needed?
  • 6. Were you able to access support in a timely manner when you needed urgent help?
  • 7. How did you first access our hospice services? (tick all that apply)

  • Section C: Care environment & facilities

  • 8. How satisfied were you with the hospice environment?

  • 9. Please rate the comfort of rooms and shared spaces:

  • 9 a)Cleanliness and comfort of rooms and shared spaces
  • 9 b) Facilities for visitors (e.g. seating, refreshments, overnight stay options)
  • 9 c) Accessibility of the hospice (e.g. parking, transport links)
  • 9 d) How important is having personal privacy to you during your stay with us, for example during personal care, rest time, or visits from loved ones?
  • 9 e) How important is it to you that conversations with doctors, nurses, or other staff can take place in private?
  • 9 f) How important is it to you to have enough space for close family or loved ones to spend time with you comfortably, including staying for longer visits if needed?
  • 9 h) How important is a quiet, calm environment for your comfort and wellbeing during your stay?
  • 9 i) If you are in a shared ward, how much does sharing a room with other patients affect your ability to rest and feel comfortable during your stay?

  • Section D: Quality of care provided

  • 10. How satisfied are you with the care provided by hospice staff?

  • 11. How satisfied are your with the following aspects of care?

  • 11. a) Compassion and dignity shown to the patient
  • 11. b) Management of pain and sypmtoms
  • 11. c) Respect for personal preferences and cultural/religious needs
  • 11. d) Emotional and psychological support provided
  • 12. Did the hospice staff involve you in care decisions?
  • 13. Were you given clear information about treatment options and care plans?

  • Section E: Family and bereavement support

  • 14. How well did the hospice support family members and carers?
  • 15. Did you receive enough information and guidance on what to expect during end of life care?
  • 16. Have you accessed any of our bereavement support services?
  • 17. If you have used our bereavement support services, how helpful did you find them?

  • Thank you for your feedback

  • Would you like to be contacted to follow up on your comments

  • If yes please complete your details below

  • Would you like to be kept up to date with hopsice news and ways you can support?
  • If yes please fill out the details above and tick below to let us know how you would like to hear from us

  • You can change your mind about your contact preferences at any time, please visit www.dovehouse.org.uk/privacy-policy

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