Healthcare Professionals Survey

Stakeholder Professionals Survey

 
Hospice Residence Facility
Professionals Survey

We are studying the feasibility of a hospice residence facility in St. Lawrence County operated by Hospice and Palliative Care of St. Lawrence Valley(HPCSLV.) The proposed HPSLV facility would provide a home-like setting with 24-hour care. The study is being conducted by the Honors Program of Clarkson University under the direction of Jennifer L. Ball, Ph.D, principal investigator.
Under New York law and regulations, certified hospices can provide two types of care in a facility. A hospice residence serves people who are appropriate for the routine level of hospice care, but who are unable to remain at home and is capped at eight beds. A hospice in-patient facility provides an inpatient level of care for hospice patients who have acute needs. New York has determined that St. Lawrence County has a capacity for four dedicated hospice in-patient beds. The maximum size for a combined facility in St. Lawrence County is twelve beds.
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1. INFORMED CONSENT
INTRODUCTION: You are being asked to participate in a research project entitled Hospice Residence Facility Feasibility in St. Lawrence County which is being conducted by the Clarkson University Honors Program, with principle investigator, Jennifer Ball, Ph.D. This survey is confidential. The study will most likely result in publication of information provided in the surveys. However, all information that could identify individual participants will be removed.
PURPOSE: Hospice and Palliative Care of St. Lawrence Valley (Hospice SLV) is evaluating the feasibility of establishing a hospice community residence, designed to accommodate those for whom in-home care is impractical.
The purpose of this study is to gain professional insight regarding the feasibility and design of a hospice residence facility.
CONFIDENTIALITY: The survey is confidential. All responses will be returned to the principal investigator and not Hospice PCSLV. The information gathered will be securely retained the principal investigator. In addition, the investigator has signed a HIPPA Business Associate Agreement with Hospice PCSLV. Please make sure to close browsers and a secure computer for the survey in order to minimize security risks.
COSTS and COMPENSATION: There is no charge to you for being in this study. You will also not receive any payment for being in this study. Your information will not be sold.
RISKS: Risks associated with the study are slight and limited to temporary emotional discomfort. Although you may find some of the questions briefly upsetting, there are no anticipated long-term risks to you related to your participation in this study. If any questions asked at any time during this survey cause you to remember personally traumatic or emotional experiences, and you feel the need to talk to a trained professional about these memories, you may wish to contact, the counseling center at Hospice PCSLV of Saint Lawrence Valley by phone at (315) 265-3105.

STOPPING THE STUDY: Your participation in this survey is voluntary. You can choose to refrain from answering any particular question at your discretion. You may choose at any time to end your participation in the group or refuse to participate in the study without penalty or loss of benefits to which you are otherwise entitled.
IRB REVIEW: This study has been approved by Clarskon University’s Institutional Review Board (IRB) review in accordance with Federal regulations. The IRB, a university committee established by Federal law, is responsible for protecting the rights and welfare of research participants. If you have concerns or questions about your rights as a research participant, you may contact Dr. Johndan Johnson-Eilola, Associate Chair of the Clarkson University Institutional Review Board (IRB) for human subjects research at (315)268-6488 or Johndan@clarkson.edu
QUESTIONS: Questions regarding the purpose or procedures of the research should be directed to the principal investigator Jennifer Ball, who may reached by phone at (315) 268-4208 or by email jball@clarkson.edu.
CONSENT: By participating in this survey and checking below, you certify that you are at least 18 years of age and you authorize Hospice SLV as well as Clarkson University to utilize the responses collected as part of the aforementioned research.
2. Have you worked with HospicePCSLV?
3. How many of your patients has HospicePCSLV served in the last 12 months?
4. If you have ever referred a client/patient, where did hospice care take place?
Please check all that apply.
5. Please complete the following statement.
In the past 12 months, I have seen clients/patients that
6. Do you know of clients/patients who were transferred out-of-county to meet their end-of-life care needs?
7. Please indicate whether you agree or disagree with the following statements.
AgreeDisagreeNot sure
I would refer clients/patients without a caregiver at home to a hospice residence facility.
I would refer clients/patients without an able caregiver at home to a hospice residence facility.
I would refer clients/patients to an in-patient hospice residence facility.
I would refer hospitalized clients/patients to a hospice residence facility.
I would refer hospitalized clients/patients to a in-patient hospice residence facility.
I would refer nursing home clients/patients to a hospice residence facility.
I would refer nursing home clients/patients to a in-patient hospice residence facility.
8. In your opinion, where do you think most people faced with end-of-life care would choose to die?
Please rank the following options.
1
1
2
3
4
5
6
9. Please indicate whether you agree or disagree with the following statements
Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Sure
I believe hospice care is appropriate end-of-life care.
There is a need for a hospice residence facility in St. Lawrence County.
There is a need for a hospice residence facility to have in-patient beds.
It is worth the capital investment to build a hospice residence facility in the county.
I believe a hospice residence is a county priority for end-of-life care services.
Hospice and Palliative Care of St. Lawrence County should oversee a residence facility.
10. The remaining questions are meant to collect demographic information from respondents so we can determine if there has been adequate response among stakeholder groups.

In what township do you clients/patients primarily reside?
11. Please estimate how the percentages of your clients/patients that travel the following distances to reach your location.
12. What is the primary population you serve?
13. What is your profession?
Please indicate specialty or sub-field for clarity.
14. Please use this space to share any comments you have regarding hospice, HospicePCSLV, or a hospice residence facility in St. Lawrence County.
15. Please share comments about what you believe would contribute to or detract from a home-like setting in a hospice residence facility.
16. The following information is optional.
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