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The Current State of Palliative Care
Program Evaluation
We appreciate your participation in this continuing education activity. Your responses to our survey w
ill allow us to improve our program offerings and services.
T
hank you for your time!
For each statement provided below, please circle the number on the 1 to 5 scale that best reflects your opinions about today’s conference.
Using the scale: 1= Strongly Disagree 2= Disagree 3= Somewhat Agree 4= Agree 5= Strongly Agree
*
I feel that as a result of this activity I will be better able to:
(Required.)
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Explain indications for palliative care and methods for prognostication
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Identify resources available in palliative care at Care New England in 2021
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
*
For each statement provided below, please check the number on the 1 to 5 scale that best reflects your opinions about today’s session.
(Required.)
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
There was enough time to cover the topic
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
I would recommend this session to my peers
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
The information was applicable to my daily activities
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
*
What were the major strengths of today’s session?
(Required.)
Describe any perceived commercial bias.
*
Was today’s topic one that you would have identified as important to you?
(Required.)
Yes
No
*
Amount of time I spent at this activity:
(Required.)
15 minutes
30 minutes
45 minutes
60 minutes
Please share any additional comments and suggestions. Your feedback is extremely valuable to us.
*
Please indicate what type of certificate you are requesting:
(Required.)
CME (1.0 AMA PRA Category 1 Credit)
Certificate of Attendance
None
Please list your information below so we may send you a Certificate:
Name and Credentials
Company
State
Email Address