Will you
take the "Encourage Living Will Survey"?

What is this "ENCOURAGE Living Will Survey Research" all about?

A peaceful and timely dying...
While NOT most people's favorite topic, when stated as a goal…
this is what most people want for the last chapter of their lives.
What do they NOT want? A prolonged dying with suffering. They also do NOT want a premature dying.

This survey’s “nickname” is “ENCOURAGE” because it asks:
“Will you be ENCOURAGED to complete a Living Will?
And will you ENCOURAGE your loved ones and close friends to complete Living Wills?”
Why complete Living Wills? To feel confident that others will honor the end-of-life wishes you expressed... so you can attain a peaceful and timely dying.

Our goal is to reduce the suffering of millions of terminally ill patients and their family members as much as possible, especially if they face the huge challenges of Advanced Dementia.
When you hit the “DONE” button, you will be directed to a web page where you can ENTER your email address so you can be sent a “Secret Code”; that way, your responses can be anonymous.

Question Title

1. Do you want to learn more about Living Wills and participate in this research? If so, the San Diego Dementia Consortium can assign a “Secret Code” to your email address so the Research Team can send you a survey for you to answer anonymously.

Yes. I want to learn about Advance Care Planning and to participate in this research.

No thanks. Do not send me anything.

Question Title

2. Please indicate how you discovered this research about Living Wills.
Select as many items below as apply:

I don't really know. (Some people were randomly selected.)

A relative suggested it.

A close friend suggested it.

Someone in my company or organization sent me an email.

I saw the postcard, "Will you take the ENCOURAGE Survey?"

End-of-Life University (internet radio program)

I read about the survey on the Internet.

I heard about the survey on the radio or TV.

I read about the survey in print media.

I heard about the survey in a lecture or workshop.

A healthcare professional who knows me suggested that I participate.

A chaplain or religious leader suggested it.

An attorney suggested it.

I already knew about other offerings from one of the organizations that are doing this research.

Other (please specify):

Question Title

3. While research is important, our clinicial responsibility comes first, if you need our help.
If completing a Living Will is URGENT for you, or for someone you know,
you can click on the appropriate box below so that someone contacts you soon.

For example, suppose your mother has early dementia.
Some days are good and she is lucid enough to make decisions, but some days are bad, when she cannot.
Also suppose her good days are getting fewer and the time she is lucid is getting shorter...
You may then feel it is URGENT to have a clinical assess her mental capacity to make decisions and to memorialize her decisions NOW regarding what treatment she does or does not want in the future -- while she still can express herself. In that case, click on the first box below.

Yes, it is urgent. Please have someone contact me as soon as possible.

No it is not urgent. Just assign a secret code so I can participate in this research.

Add anything else you wish here:

Question Title

1. Do you want to learn more about Living Wills and participate in this research? If so, the San Diego Dementia Consortium can assign a “Secret Code” to your email address so the Research Team can send you a survey for you to answer anonymously.

Question Title

2. Please indicate how you discovered this research about Living Wills. Select as many items below as apply:

Question Title

2. Please indicate how you discovered this research about Living Wills.
Select as many items below as apply: