Table 3 Pre-Family Meeting Primary Family Carer Questionnaire
From: Family meetings in palliative care: Multidisciplinary clinical practice guidelines
Nb Conducted by phone [] or face to face [] by Family meeting convenor ............ [insert name] | |
Now that I have explained about the family meeting and you have agreed to attend it would be useful for us if we had some more information in order to prepare for the family meeting. | |
What are the main issues for you at the moment? | |
(a) Greatest concern: | |
................................................................................................................................................................ | |
(b) Second greatest concern: | |
................................................................................................................................................................ | |
How upset/worried are you about these concerns? (Place a cross on the line) | |
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(1) Not at all | As worried as I could possibly be (10) |
How often do these concerns arise? (Place a cross on the line) | |
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(1) Not at all | All the time (10) |
Are there other difficulties you are coping with now? Please outline below: | |
............................................................................................................................................................... | |
............................................................................................................................................................... | |
How much is the problem (or problems) interfering in your life? (Place a cross on the line) | |
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(1) Not at all | Dominating my life completely (10) |
How confident do you feel in dealing with the problem(s)? (Place a cross on the line) | |
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(1) Not at all | Extremely (10) |
What questions would you like to ask at the family meeting? | |
............................................................................................................................................................... | |
If you think of other questions between now and the family meeting, please write them down and bring them with you to the meeting. | |
Adapted with permission from Single Session Therapy Resource Guide (The Bouverie Centre 2006) | |