Thank you for taking the time to complete this survey.  Your answers are anonymous and you will not be identifiable.  However, if you wish to discuss this matter in more detail please indicate this below. 

Healthwatch Southampton will share the results of this survey with the resuscitation committee at Southampton General Hospital and will discuss the results with them.  It is expected that the findings of this survey will add direction to the decisions made by this committee.  If appropriate Healthwatch Southampton will share the findings with the commissioners of healthcare and other healthcare providers in order to ensure that patient views are given full consideration in these matters.

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* 1. Have you heard of this term (DNACPR) before?

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* 2. What is Cardio-Pulmonary Resuscitation (CPR)?

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* 3. When possible anticipatory decisions about DNR/CPR are best made well in advance. At what point do you think doctors should discuss this with patients?

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* 4. Do you think your family/partner should be involved in the discussion about resuscitation as well?

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* 5. If you are not able to discuss it do you think it should be discussed with your next of kin?

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* 6. Do you think it is ever appropriate for doctors to make a decision they believe is in your best interests, but not discuss it with you or your closest family?

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* 7. Do you understand the term ‘advanced decision’?

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* 8. If a Do Not Attempt Cardio-Pulmonary Resuscitation decision was made, would you expect the patient to be allowed to have intravenous fluids/antibiotics/pain relief/care/intensive care?

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* 9. Do you have any additional concerns/comments?

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