Thank you for taking the time to complete this survey about Advance Care Planning activities in BC specific for people living with dementia and Family/Friend Caregivers. 

The survey is part of a new initiative funded by Public Health Canada and led by the BC Centre for Palliative Care in collaboration with Alzheimer’s Society of BC, Family Caregiver of BC, United Way and academic researchers.  

The survey will only take 10-15 minutes to complete.  

Please note that the survey will be closed on February 28, 2020.  

If you have any questions about the survey, please contact Nicole Chovil (NChovil@bc-cpc.ca) or if you would like more information about the initiative please contact Dr. Eman Hassan, executive director of BC Centre for Palliative Care (ehassan@bc-cpc.ca

We appreciate your contribution to the project.   

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* 1. What is the name of your organization?

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* 2. What area of BC does your organization serve? (Please check all that apply)

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* 3. What is your role within the organization?

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* 4. Among the people that you serve, does your organization often serve: (Please select all that apply)

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* 5. Is your organization currently conducting any Advance Care Planning activities for the public? (e.g., information sessions; workshops; provision of planning tools)

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* 6. What Advance Care Planning resources for the public is your organization currently using? (Select all that apply)

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* 7. Have you experienced any barriers in delivering Advance Care Planning activities to people living with dementia and family caregivers? Please explain.

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* 8. In your experience, what are some of the attitudes/reactions that people living with dementia or their family caregivers have about Advance Care Planning?

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* 9. Is your organization currently conducting any Advance Care Planning activities tailored specifically for individuals living with dementia and their family/friend caregivers?

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* 10. Does your organization use any Advance Care Planning materials developed specifically for individuals living with dementia and family caregivers?

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* 11. In your opinion, what are some of the barriers to early initiation of Advance Care Planning conversations between individuals living with dementia and their family/friend caregivers?

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* 12. In your opinion, what are some of the barriers to early initiation of Advance Care Planning conversations between individuals living with dementia and their healthcare provider?

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* 13. In your opinion, what are some strategies that can facilitate early initiation of Advance Care Planning conversations between individuals living with dementia and their family/friend caregivers?

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* 14. In your opinion, what are some strategies that can facilitate early initiation of Advance Care Planning between individuals living with dementia and their healthcare provider?  

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* 15. Do you have any other thoughts or suggestions regarding early initiation of Advance Care Planning in people living with cognitive impairment or dementia?

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* 16. May we contact you for a short follow-up phone interview?

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