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Table 2 Proposed follow-up survey to collect participants’ experience with the CPOT-Fam and accompanying educational module and their perceptions of pain in the ICU

From: Study protocol: development and pilot testing of the Critical Care Pain Observation Tool for families (CPOT-Fam)

A follow-up survey to solicit participants’ experiences with pain in the ICU and the pain education module (draft)
1) How comfortable do you feel in your ability to tell whether your family member is experiencing pain? (If applicable)
O Very comfortable
O Moderately comfortable
O Not comfortable or uncomfortable
O Moderately uncomfortable
O Very uncomfortable
2) If you identify pain in your family member, do you feel empowered to act on this information? (If applicable)
O. Yes
O. No
Why or why not?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3) What would you do if you identified pain in your family member?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4) Please describe your experience with using the CPOT-Fam in a few words
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5) Please describe your experience with the educational module (i.e., videos) in a few words
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________