ACP Engagement Survey

ACP Engagement Survey

Thank you for your interest in the Advance Care Planning Engagement Survey.

Anyone may use the Survey or translate it into other languages.

Please complete this form and review the Terms of Use below to access the Survey.

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Terms of Use

The Survey is covered under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/). Under the license, anyone is free to use the Survey or translate it into other languages.

However, individuals cannot sell the Survey or modified Surveys and cannot put the Survey(s) on a website other than the PREPAREforYourCare.org website.

Because the Survey is validated as written, we do not recommend modifying the Survey wording or response options. You can download the most recent versions of the Advance Care Planning Engagement Survey on our research page. This document also describes how to analyze data from the Survey.

If you translate or modify the forms, you must send information back to our PREPARE team (info@prepareforyourcare.org) about the methods used, any pilot testing or validation work for the modified form, and the actual survey to house on the PREPARE website, so it can be shared with others. This is a stipulation of the grant funding that supported the development of the Survey.

If you translate (or modify) the Survey, you must include the following language on the form about the Creative Commons license and acknowledge the Regents of the University of California. If you decide to move forward, you must add the following information on the survey:

“The translation and this work is a derivative of The Advance Care Planning Engagement Survey by © 2013 The Regents of the University of California, www.PREPAREforYourCare.org. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, https://creativecommons.org/licenses/by-nc-sa/4.0/. UC Regents provides no warranties or endorsements.”

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