We would like to offer you our sincere sympathy. The death of a loved one is never easy. Thank you for considering completing this survey about how the person you cared about was looked after in this Trust at the very end of their life. By answering these questions, you will help us to make changes to improve services for all our patients in the future. We understand that this is a difficult time so if you feel that you do not want to complete this survey right away, or indeed at all, please don't feel under pressure to do so.

If these questions bring back painful memories and you wish to talk about them, please contact the Chaplaincy on 020 8869 2112 or your GP, or at the end of the survey you will find phone numbers of local bereavement agencies which can also help. Thank you.

* 1. You don’t need to tell us the name of the person who died (unless you want to). To help us direct the learning from this questionnaire, please tell us:

* 2. How soon before your relative/friend died were you made aware that this was likely to happen?

* 3. Did it help you to know this?

* 4. Did you feel you had enough privacy when you were told your relative/friend may die?

* 5. How would you rate the way hospital staff spoke to your relative/friend?

* 6. Were you given information that was easy to understand?

* 7. Do you think your relative/friend was given information in a way that was easy to understand?

* 8. Did you feel the personal wishes of your relative/friend were respected by those caring for them?

* 9. Were religious and cultural beliefs taken into consideration by those caring for them?

* 10. Do you feel that you were given all the support from hospital staff that you wished to receive?

* 12. Were you or your relative/friend offered the chance to have religious/spiritual support?

* 13. Do you think your relative died in the right place?

* 14. Do you feel that staff in the bereavement office spoke to you sensitively and with compassion?

* 15. If you visited the mortuary, did you feel that staff spoke to you sensitively and with compassion?

* 16. If you would like to tell us anything else about your relative/friend’s last days in hospital, please do so.

Contacts for bereavement support:

Bereavement Care (Harrow and Hillingdon)    020 8427 5720
Bereft Bereavement Support (Ealing)                020 8896 2800
Brent Bereavement Service - BBS                      020 8459 6818
CRUSE (National helpline)                                  0808 808 1677
Jewish bereavement                                             020 8951 3881
Asian family counselling                                       020 8813 9714
The Child Bereavement UK                                 0800 02 888 40
The Way Foundation                                             www.widowedandyoung.org.uk

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