The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Experience with End of Life Care and Bereavement Support in MND: A National Survey

Returning?

A A A

Dear Participant,
Thank you for contributing to our study exploring the experiences and support needs of people who have recently been bereaved because of MND. The information from this survey will help to improve bereavement supports and services in the community. We value your participation. Your information will be protected by La Trobe University's strict privacy and confidentiality rules. You and your individual answers will not be identified.
Not all questions will apply to every situation but we would like to have some background information on you and your deceased partner/relative/friend, the end of life care they received, what bereavement services you accessed and how helpful they were. We are also interested to know what you feel could have worked better for you, and, importantly, how you are feeling now.
You may find some of the questions difficult as you recall your loss. However, in our previous work, many bereaved people have told us that participation in research was helpful. If you feel distressed at any time during completion of the questionnaire, or after completion, please contact the MND Association in your state (1800 777 175) or refer to the list of support services accompanying this questionnaire.
If you have a disability that makes it difficult for you to complete the form without assistance, or want further information regarding the survey, please contact the Research Officer, Denise Howting, on d.howting@latrobe.edu.au
Please complete this questionnaire if you were the closest person to the deceased. The survey should take approximately 30 minutes to complete.

Thank you for helping us with this research

We greatly value your participation

This survey has 7 sections:

Section 1 - Is about you as the carer or the closest person to the deceased
Section 2 - Is about your deceased partner/relative/friend
Section 3 - Is about your experience caring for your partner/relative/friend with MND
Section 4 - Is about exploring your current feelings
Section 5 - Is about the bereavement support you received after your partner/relative/friend died
Section 6 - Is about your experience with your MND Association in end of life care and bereavement support
Section 7 - Further comments

For each question, please tick or mark the appropriate box, for example,
Are you:  Male  Female
Or write your response in the space provided.

1.1 Are you ...?

* must provide value

Male

Female

reset

1.2 How old are you?

* must provide value

1.3 What is your current marital status?

Never married

Married or de facto

Separated or divorced

Widowed

Other (please specify below)

reset

1.3a Please specify other marital status

1.4 What is your cultural background?

Australian

Other English speaking (For example: British, New Zealander, etc.) please specify below

Non-English speaking (For example: Italian, Malaysian, etc.) please specify below

reset

1.4a Please specify other English speaking background (for example: British, New Zealand, etc.)

1.4b Please specify Non-English speaking background (for example: Italian, Malaysian, etc.)

1.5 Are you from an Aboriginal background or Torres Strait islander?

Yes

reset

1.6 What is your highest level of education?

No formal education

Primary school

High school

Diploma/certificate/trade qualification

University degree

reset

1.7 Currently, what is your MAIN employment situation?

Working full time (more than 30 hours a week)

Working part-time (8-30 hours a week)

Carer (full-time) of home family, etc.

Student (full-time)

Temporarily unemployed (but actively seeking work)

Retired

Other permanently unemployed (e.g., chronically sick, independent means)

reset

1.8 What is your residential postcode?

1.9 What is your religion?

No religion

Christian (e.g., Catholic, Anglican, etc.)

Other religion (please specify below)

reset

1.9a Please specify if other religion

1.10 In general, how important are religious beliefs in your day-to-day life?

Very important

Quite important

Somewhat important

Not at all important

reset

1.11 In general, how important are your spiritual beliefs in your day-to-day life?

Very important

Quite important

Somewhat important

Not at all important

reset

1.12 What was YOUR relationship to your relative/friend? YOU were their ...? (Please tick one box)

Wife/husband or partner

Girlfriend/boyfriend

Mother/father

Sister/brother

Daughter/son

Friend

Other (please specify below)

reset

1.12a Please specify if other relationship

1.13 Apart from caring with your partner/relative/friend with MND, did you have any other carer responsibilities (e.g., children, other family, etc.)

Yes (please specify below)

reset

1.13a Please specify other carer responsibilities

1.14 Since your partner/relative/friend's death from MND, what other difficult events have you had in life?
(please tick all that apply)

None

Loss of another loved one

Terminal illness

Break up of a relationship

Loss of a job

Other (please specify below)

1.14a Please specify other difficult events in life

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.