Palliative Care Provider Survey

**PLEASE NOTE THIS SURVEY IS TO BE COMPLETED BY PALLIATIVE CARE PROGRAM ADMINISTRATORS** 
 
Goals of Care Coalition of New Jersey (GOCCNJ) received grant funding from the New Jersey Commission on Cancer Research (NJCCR) to: 

 
PLEASE NOTE this survey is intended to collect capacity and program data at a high-level to inform our research. It is not intended to capture this data by specific care setting (e.g., inpatient vs. home-based care). However, recognizing that services available and delivered may vary by setting, and that palliative care programs may span multiple settings, we may follow up with organizations responding to this general survey to learn more about these nuances. If you are responding for your organization for a specific care setting, please feel free to forward this survey to other administrators of additional care settings for completion. 
 
Participation in this survey will ensure that GOCCNJ, NJCCR and the New Jersey Department of Health have the information they need about our ability to deliver palliative care services throughout the state in order to develop recommendations and advance policies to improve care for people in NJ with serious illness. 
 
The directory will enable patients and their caregivers to access palliative care services in their community that are delivered by specialists and allow healthcare providers to refer patients to 
those practices. Inclusion in the directory is free. 
 
This survey will take approximately 15 minutes to complete. Please respond by November 30th, 2023. 
 
Should you have additional questions related to the objectives of this survey, please contact Bhirschman@goalsofcare.org. 
 
Thank you for your participation, 
Ramy Sedhom, MD, NJCCR Principal Investigator
David Barile, MD, Chief Medical Officer, GOCCNJ