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Physician's Survey: a Needs Assessment Tool to Build Support

This downloadable survey is designed for leadership to distribute within their institution. It can be used as a marketing tool to help assess attitudes, educate colleagues, solicit input and build a strong case for creating a palliative care program.
Spring 2002

Physician's Survey

The 'msword file' icon listed above is the physician survey. It maybe customized to suit the needs of a specific institution.

The 'pdf document' is the instructions for the survey. It is intended for program leadership and not for the physicians themselves. These two files have different information.

You will need Adobe Acrobat Reader to read the pdf or MS Word to read the Word document. The Word version will allow changes. The pdf is static.

Additional Resources

Palliative Care: A Primer for Institutional Leaders
The first in CAPC's technical assistance series, Diane Meier, MD, Director of the Center to Advance Palliative Care, provides practical information on the design, development and management of hospital-based palliative care services.

Community Yardstick
Supportive Care of the Dying

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