Serious Illness Communication Skills Survey

Thank you for taking the time to complete this anonymous survey about Serious Illness Communication Skills. There are 9 quick questions and this should only take you 2-3 minutes.

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* 1. Based on your experience at Cedars-Sinai, do you think serious illness conversations that include patients’ health care goals, values and preferences take place as often as they should...

	Please choose:
With patients and families?	With patients and families? Please choose: menu
Across the care team?	Across the care team? Please choose: menu

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* 2. How well would you rate your serious illness communication skills?

1 - Highly Competent

3 - Adequate

5 - Opportunity for Improvement

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* 3. When you engage in conversations with patients who have serious illness, how often do you elicit a patient’s goals, values, and preferences regarding their care?

1 - Often

3 - Sometimes

5 - Not Often

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* 4. Have you had any prior education in serious illness communication?

Yes

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* 5. If yes, what was the education?

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* 6. Do you think there would be value in Cedars-Sinai providing education and resources to improve clinicians’ serious illness communication skills?

Yes

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* 7. Please specify your professional role at Cedars-Sinai:

Attending MD

Physician Trainee (Fellow)

Physician Trainee (Intern or Resident)

Allied Health Professional (NP & PA)

RN (other than a Case Manager)

Case Manager

Social Worker

Chaplain

Other (please specify)

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* 8. How many years have you been practicing in your discipline?

1-5 Years

6-10 Years

11-15 Years

16-20 Years

20-25 Years

26-30 Years

31-35 Years

More than 35 Years

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* 9. Are there any additional comments or questions you would like to share?

Thank you very much for your time.