What is a good death to you?

1) Have you ever thought about how you would prefer to die?
Yes
No

2) Where is your preferred place of death?

Home
Hospice
Care Home
Hospital
Other:

3) Who would you prefer to be with you when you die? (tick all that
apply)
Partner
Family
Friends
I want to die alone
Spiritual leader
Healthcare and/or social care professional

4) Would you prefer to die in your sleep?

Yes
No

5) If you answered "yes" to 'Would you prefer to die in your sleep?'. Why is
this?

6) If you answered "no" to 'Would you prefer to die in your sleep?'. Why is
this?
7) Would you prefer to die before your partner or significant other?
Yes I would like to die before my partner or significant other
No I would not like to die before my partner or significant other
Not applicable

8) Have you created a bucket list?

Yes
No

9) Do you belong to a religious faith?

Yes
No
I consider myself spiritual but do not believe in one religion

10) If you answered 'yes' to 'Do you belong to a religious faith?', how
important is your religious faith to you?

Not very important

1
2
3
4
5
Very important

11) What do you think the cultural barriers might be for your own
death? (tick all that apply)
Not speaking about death
Availability of care givers
Patient concerns
Not wanting to be a burden on a family
Cost of dying
Social support network
Not planning for death
Gender expectations
Family dynamics effecting decision making
Other:

2) Describe the scene at the end of your life? (for example where are you,
what are you listening to, what have you eaten and who is present)