ReSPECT Patient and Carer Feedback Questionnaire

A ReSPECT plan is intended to put the individual at the heart of decisions about their future emergency healthcare.  We would really appreciate hearing about your experience of the conversation about your ReSPECT plan. Your feedback can help us to continue to develop ReSPECT planning in Ayrshire & Arran. 

To share your views and feedback please answer the few short questions below. The questions don’t ask for any personal information and your responses will only be used to help inform future ReSPECT planning.  

With your permission, we would also like to use some anonymised feedback in NHS reports and publicity: you have the option to agree to this at the end of the questionnaire. 

 

1. Please tell us where your ReSPECT conversation took place:

 

2. Please tell us who the ReSPECT conversation was about. 

If the conversation was about someone else, please answer the questions thinking about their health issues and what matters to them. *

 

3. How much effort was made to help you understand your health issues? 

Every effort was made A lot of effort was made Some effort was made A little effort was made No effort was made 
 

4. How much effort was made to listen to what matters most to you about your health issues?  

Every effort was made A lot of effort was made Some effort was made A little effort was made No effort was made 
 

5. How much effort was made to include what matters most to you in choosing what to do next? 

Every effort was made A lot of effort was made Some effort was made A little effort was made No effort was made 
 

6. Please tell us any other feedback you would like to share.

 

7. Please tick the box below if you are happy for your anonymised feedback to be used in NHS Ayrshire & Arran reports and publicity (this could include website, social media, staff communications and local media). No personal information would be shared and quotes would be fully anonymised.