Where do you get your dialysis In the last 3 months, how often treatments? did your kidney doctors explain things in a way that was easy for 1 At home If At home, Go to you to understand? Question 45 2 At the dialysis center 1 Never 2 Sometimes 3 I do not currently receive 3 Usually dialysis If I do not currently 4 Always receive dialysis, Go to Question 45 In the last 3 months, how often did your kidney doctors show How long have you been getting respect for what you had to say? dialysis at [SAMPLE FACILITY 1 Never NAME]? 2 Sometimes 1 Less than 3 months If Less 3 Usually than 3 months, Go to 4 Always Question 45 2 At least 3 months but less In the last 3 months, how often than 1 year did your kidney doctors spend 3 At least 1 year but less than enough time with you? 5 years 1 Never 4 5 years or more 2 Sometimes 5 I do not currently receive 3 Usually dialysis at this dialysis center 4 Always If I do not currently receive dialysis at this dialysis center, Go to Question 45 In the last 3 months, how often did you feel your kidney doctors really cared about you as a KIDNEY person? Your kidney doctors are the doctor or 1 Never doctors most involved in your 2 Sometimes dialysis care now. This includes 3 Usually kidney doctors that you see inside 4 Always and outside the center. In the last 3 months, how often did your kidney doctors listen carefully to you? 1 Never 2 Sometimes 3 Usually 4 Always
Where do you get your dialysis treatments? 1 At home If At home, Go to Question 45 2 At the dialysis center 3 I do not currently receive dialysis If I do not currently receive dialysis, Go to Question 45 How long have you been getting dialysis at [SAMPLE FACILITY NAME]? 1 Less than 3 months If Less than 3 months, Go to Question 45 2 At least 3 months but less than 1 year 3 At least 1 year but less than 5 years 4 5 years or more 5 I do not currently receive dialysis at this dialysis center If I do not currently receive dialysis at this dialysis center, Go to Question 45 Your kidney doctors are the doctor or doctors most involved in your dialysis care now. This includes kidney doctors that you see inside and outside the center. In the last 3 months, how often did your kidney doctors listen carefully to you? 1 Never 2 Sometimes 3 Usually 4 Always In the last 3 months, how often did your kidney doctors explain things in a way that was easy for you to understand? 1 Never 2 Sometimes 3 Usually 4 Always In the last 3 months, how often did your kidney doctors show respect for what you had to say? 1 Never 2 Sometimes 3 Usually 4 Always In the last 3 months, how often did your kidney doctors spend enough time with you? 1 Never 2 Sometimes 3 Usually 4 Always In the last 3 months, how often did you feel your kidney doctors really cared about you as a person? 1 Never 2 Sometimes 3 Usually 4 Always KIDNEY
ICH_SurveyAdminManual_Ver4_Feb2016.docx