POST-COAST SURVEY Questions for Providers
You are invited to take part in a study looking at whether Introducing and implementing a transferable, readily accessible, and actionable end of life planning tool for patients with advanced serious illness or frailty is acceptable in southern New Zealand. Whether or not you take part is your choice. If you don’t want to take part, you don’t have to give a reason, and it won’t affect your career.

You have been selected for participation in this study because you provide care to patients with advanced and progressive illness and/or frailty, thought to be in their last year of life, and may have completed a COAST form, as part of a local pilot initiative.

Through completing the online survey, your consent for us to use this information for the purposes of this study will be assumed. However, formal written consent forms will be available if you would prefer.
Where do you work? *
What do you know about the COAST form and process? *
Your answer
How many of your patients/clients have had a completed COAST form? *
Did you receive adequate education and training about the COAST form and process? *
Your answer
What works well about the COAST form and process? *
Your answer
How much do you agree with the following statement: The COAST form improves the care provided to my patients/clients? *
What barriers are there to COAST form completion? *
Your answer
What barriers are there to COAST form implementation? *
Your answer
How comfortable are you completing the COAST form? *
How comfortable are you following the COAST form orders if you yourself did not complete and sign the form? *
How could the COAST form be improved? *
Your answer
What other thoughts do you have about the COAST form or about advance care planning in general?
Your answer
If you would like a written consent form and information sheet sent to you please leave your name and postal address below:
Your answer
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