End-of-Life Care Preferences Survey

Improve End-of-Life Care with Compassionate Patient Feedback

End-of-life care conversations are among the most important discussions in healthcare, yet they're often rushed, unclear, or inadequately documented. This End-of-Life Care Preferences Survey helps hospitals, hospices, palliative care teams, and healthcare systems gather meaningful feedback about advance care planning, code status discussions, palliative care referrals, and family meeting facilitation.

Whether you're a healthcare administrator, palliative care coordinator, hospital quality improvement team, or patient advocate, this template provides a thoughtful framework for understanding how well your organization supports patients and families during life-limiting illness.

Designed for Healthcare Quality Improvement

This survey addresses critical quality indicators in end-of-life care:

• Advance directive completion support – Assess whether patients felt supported in completing advance directives and understanding their options
• Code status discussion quality – Evaluate how clearly physicians communicated about resuscitation preferences and treatment goals
• Palliative care referral timeliness – Measure whether palliative care services were offered at the appropriate time in the illness trajectory
• Family meeting facilitation – Understand patient and family satisfaction with care conferences and shared decision-making

Built for Sensitive Conversations

Paperform's flexible design lets you create surveys that feel respectful and human, not clinical and transactional. Customize fonts, colors, and language to match your organization's compassionate care philosophy. Use conditional logic to tailor questions based on whether patients received specific services, ensuring relevance without overwhelming respondents.

The anonymous response option encourages honest feedback, while optional contact fields allow patients or family members to request follow-up if they choose. Success pages can provide links to grief resources, patient advocacy contacts, or additional support services.

Streamline Analysis and Reporting

Connect this survey to Stepper to automatically route responses into quality improvement dashboards, trigger alerts for negative feedback requiring immediate attention, or compile monthly reports for hospital ethics committees and palliative care teams. Integration with Airtable, Google Sheets, or Notion keeps all feedback organized and accessible for analysis.

Use Paperform's AI Insights to identify common themes across responses, highlight areas of excellence, and pinpoint opportunities for staff training or process improvement in advance care planning.

HIPAA Considerations

Please note that Paperform is not a HIPAA-compliant solution. For surveys involving protected health information, ensure you anonymize responses or use this template in conjunction with your organization's HIPAA-compliant systems. This survey template is designed to collect quality improvement feedback rather than detailed clinical information.

Trusted by Healthcare Organizations

Healthcare systems, hospices, palliative care programs, and patient experience teams trust Paperform for sensitive patient feedback collection. With SOC 2 Type II compliance, secure data handling, and thoughtful design options, you can gather the insights needed to improve end-of-life care with dignity and respect.