From: Family meetings in palliative care: Multidisciplinary clinical practice guidelines
Nb Conducted by phone [] or face to face []. Completed by ............ [insert name] | |||
As a follow up to the recent family meeting we are interested in finding out how things are for you at the moment. Before the family meeting | |||
You nominated: | |||
................................................................................................................................................................. | |||
as the main problem to be discussed at the family meeting, and | |||
................................................................................................................................................................. | |||
as your second greatest problem. | |||
How upset/worried are you about this problem (or these problems) at the present time? (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 problems happen? (Place a cross on the line) | |||
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(1) Not at all | All the time (10) | ||
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) | ||
In what ways?........................................................................................................................................... | |||
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) | ||
You nominated the following questions as those you would like addressed in the family meeting: | |||
................................................................................................................................................................. | |||
To what extent do you feel these questions were addressed? | |||
................................................................................................................................................................. | |||
Office use only: | Â | Â | Â |
 | Pre-session | Post-session | Difference |
How upset/worried: | ........................ | ........................ | ........................ |
Problem frequency: | ........................ | ........................ | ........................ |
Life interference: | ........................ | ........................ | ........................ |
Confidence: | ........................ | ........................ | ........................ |