Palliative Medicine Survey Questionnaire e
Palliative Medicine Survey Questionnaire e
Palliative Medicine Survey Questionnaire e
QUESTIONNAIRE
Canadian Society of Palliative Care Physicians
Canadian Medical Association
College of Family Physicians of Canada
Royal College of Physicians and Surgeons of Canada
Technology Evaluation in the Elderly Network
November 2014
Palliative Medicine Survey
Are you:
a licensed physician in full or part-time practice, a locum, in a medically related field, or on a
leave of absence
student
resident
completely retired
A. ABOUT YOU
2. You are:
female
male
2
6. Province/territory where you primarily work?
British Columbia Nova Scotia
Alberta Prince Edward Island
Saskatchewan Newfoundland and Labrador
Manitoba Yukon
Ontario Northwest Territories
Quebec Nunavut
New Brunswick
7. The remaining survey questions depend on the extent to which you practice
palliative medicine, as determined by the following question.Do you practice
Palliative Medicine by: a) providing palliative care consultations & direct follow-
up visits; and / or b) acting as a palliative care resource to other care providers;
and / or c) providing indirect care as part of a local/regional palliative care
service?
Yes (Please skip to question 8)
No (Please answer questions B1 and B2 and return the survey)
B1. Are you able to refer patients to Palliative Care services in your area?
Full access
Some access
No access
Comments:
B2. Are you satisfied with the services available to your patients at end of life?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Not applicable
Comments:
3
8. How many hours per week on average excluding on-call, do you practice
medicine (including clinical, teaching, administration, research, etc.)?
9. How many hours per week do you spend doing Palliative Medicine (including
clinical, administration, teaching, academics, etc.)?
10. Are you a member of: (please select ALL that apply)
Canadian Society of Palliative Care Physicians
Canadian Hospice Palliative Care Association
Provincial Hospice Palliative Care Association
Provincial Section of Palliative Care/ Medicine (if applicable)
Other Palliative Care organizations
None of the above
4
11c. What Canadian site?
University of British Columbia Queen’s University
University of Calgary University of Ottawa
University of Alberta McGill University
University of Manitoba Université de Montréal
University of Western Université Laval
McMaster University Dalhousie University
University of Toronto
5
13. Do you have post-graduate training in addition to your medical degree (e.g.,
Masters, PhD)?
Yes
No
13a. What additional training do you have? (Select all that apply)
M.Sc.
MBA
M.Ed.
PhD
Other
14. Please indicate the number of years that you have been working in Palliative
Medicine (full or part-time)?
15. In your geographic area: Palliative Care is provided by: (Select ALL that
apply)
Family physician (own patient)
Specialist (own patient)
Specialty Palliative Care Team
Home Health
Other, please specify... ______________________
16. With respect to your MAIN practice setting where you provide palliative
care, select the palliative care population PRIMARILY served by you.
Urban/suburban
Small town
Rural
Geographically isolated/remote
Cannot identify a primary geographic region
6
17. In the clinical element of your palliative medicine practice, what percentage
of patients have a non-cancer diagnosis?
Less than 20 %
21-50 %
More than 50 %
18. What percentage of your Palliative Medicine practice do you spend on the
following. Your answers MUST total 100%.
Clinical work
Research
19. Of the time you spend doing clinical palliative care, what percentage of time
do you spend in each setting? Your answers MUST total 100%.
Palliative care unit where palliative care physician is the most responsible
physician
Residential hospice
Office practice
Patient’s home
Cancer clinic
7
19a. Other setting, please specify:
20. Do you do unpaid / volunteer work related to palliative care outside of your
regular practice hours (e.g., boards, committees)?
Yes
No (skip to question 21)
22. Do you provide telephone advice to other physicians or other health care
providers about palliative care?
Yes
No (skip to question 23)
22a. How many such telephone calls do you do on average per week?
1-5
6-10
11-15
16-20
> 20 calls/week
8
22b. Do you receive an additional fee for these calls?
Yes
No
23. Do you provide after-hours on call / coverage for palliative care (time
outside of regularly scheduled activity during which you are available to
patients)?
Yes
No (Skip to question 24)
23c. When you are on call/providing coverage, do you provide mostly telephone
support?
Yes
No
9
23d. When you are on call/providing coverage, please indicate the average
number of hours spent on direct patient care (e.g. ward rounds, phone, e-mail
or face-to-face) per month?
1-5
6-10
11-20
> 20
23e. Are you reimbursed separately for being on call / providing coverage?
Yes
No
23f. Are you paid extra for providing direct patient care (e.g. phone, e-mail or
face-to-face) while on call?
Yes
No (Skip to question 23h)
23g. If you are paid extra for direct patient care, how is this funded?
Fee for service
Contract
Sessional
Other, please specify... ______________________
23h. Do you get days off in lieu of time spent on weekend call?
Yes
No
10
24a. Who is on your team? (Please select all that apply)
Other Palliative Care Physician(s) Spiritual Care Practitioners
Nurse practitioner/CNS PT/OT
Advanced Practice RN Recreation therapist
Registered Nurse (RN) Psychologist
Home Care RNs Volunteer
Primary Care Physician Music therapist
Pharmacist Respiratory therapist
Social worker Other, please specify... ______________________
24c. Are all newly referred patients requiring face-to-face consultation seen by
a palliative care physician?
Yes
No
24d. How many hours per week do you dedicate to interprofessional team
activities, where some or all of the team is present? (e.g. team rounds/meetings
or case reviews)
1-3
4-6
7-10
> 10 hours
F. PROFESSIONAL DEVELOPMENT
25. How many days per year do you spend on CPD/CME activities?
1-3 13-17
4-7 18-21
8-12 > 21 days/year
11
25a. Are you reimbursed for your CPD/CME time?
Yes
Sometimes
No
G. ACADEMIC APPOINTMENTS
26d. How many days per month do you spend on academic work (non-clinical
work/teaching)?
1-5 11 - 15
6 - 10 > 15
12
26e. Do you have the option of paid sabbatical leave?
Yes
No
27. How many children (up to age 18) do you provide palliative care for in an
average year? (enter number)
28. How would you describe your comfort level in dealing with pediatric
palliative patients?
Very comfortable
Somewhat comfortable
Adequate
Somewhat uncomfortable
Very uncomfortable
29b. How much support do you receive from formal pediatric palliative care
services?
Full support Minimal support
Moderate support No support available
13
29c. Are you satisfied with the services available to your pediatric patients at
end of life?
Very Satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Not Applicable
Comments:
30. What percentage of your palliative medicine income is provided by: (total
MUST be 100 %)
Fee for service insured
Salary
Capitation
Service contract
Other
Cannot estimate
Prefer not to answer
14
31. How does compensation for palliative care services compare to other areas
of practice?
Equivalent More Less Don't
than than know
Other areas of focused practice (e.g
Hospitalists)
Full practice family medicine
Full practice specialty care
33. Do you know the approximate payment per hour that you receive from your
Palliative Medicine practice?
Yes
No (Skip to question 34)
34. Do you also receive personal benefits or other supports as part of your
payment system?
Yes
No (Skip to question 35)
15
34a. Which personal benefits or other supports do you receive? (Select ALL
that apply)
Office space Paid holiday time
Administrative assistant time Paid CPD/CME time
Travel allowance Conference registration fees
Medical /dental Telecommunication devices (pager, cell
Pension phone, laptop)
J. PROFESSIONAL SATISFACTION
35. Please rate your satisfaction with each of the following aspects of Palliative
Medicine:
Very Somewhat Neutral Somewhat Very N/A
satisfied satisfied dissatisfied dissatisfied
Your relationship with your
patients
Your relationship with hospitals
Your relationship with specialist
physicians
Your relationship with family
physicians
Your relationship with other
interdisciplinary team members
The availability of CME/CPD
opportunities to meet your
needs
Your ability to find locum
coverage for CME/CPD,
holidays, personal time
Your current professional life
The balance between your
personal and professional
commitments
Your remuneration
16
36. With reference to your Palliative Medicine practice, please indicate if you
plan to make any significant changes in the next five years:
Yes No
a) Reduce work hours
b) Transition to another discipline in Medicine
c) Retire
d) Increase your working hours
Comments:
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