End-of-Life Traditions and Cultures What is your age? Question Title * 1. What is your age? Under 18 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older OK What is your nationality? (Ex: 50% Irish, 50% Italian) Question Title * 2. What is your nationality? (Ex: 50% Irish, 50% Italian) OK What is your current religion, if any? Question Title * 3. What is your current religion, if any? Christian/Protestant/Methodist/Lutheran/Baptist Catholic Mormon Greek or Russian Orthodox Jewish Muslim Buddhist Hindu Atheist or agnostic Nothing in particular Other (please specify) OK What most influenced your choice of religion? Please explain. Question Title * 4. What most influenced your choice of religion? Please explain. Family Influence Educational Influence Self Established Other (please explain) OK In what country do you currently live? Question Title * 5. In what country do you currently live? United States Other (please specify) OK Have you ever experienced the loss of a loved one? Question Title * 6. Have you ever experienced the loss of a loved one? Yes No OK What influences your traditions surrounding death? Question Title * 7. What influences your traditions surrounding death? Culture-based traditions Religion-based traditions Both Neither Other (please specify) OK What is your level of knowledge of hospice care? Question Title * 8. What is your level of knowledge of hospice care? Very knowledgeable Somewhat knowledgeable Somewhat unknowledgeable Very unknowledgeable OK Do you have an idea of how you expect to be taken care of when you pass? Question Title * 9. Do you have an idea of how you expect to be taken care of when you pass? No Yes (please specify: burial, cremation, etc.) OK What is your level of comfort talking about death? Question Title * 10. What is your level of comfort talking about death? Extremely comfortable Very comfortable Somewhat comfortable Not so comfortable Not at all comfortable OK DONE