2020 ACP Day Survey April 16th was National Advance Care Planning Day. Each year, the 'Speak Up' Advance Care Planning in Canada initiative launches a campaign toolkit and communication plan. After ACP Day, we circulate this survey to monitor events and activities going on across the country, and to identify ways we might improve our ACP Day campaign efforts in the future. If you aren't familiar with our campaign, please go to our website for more information: (http://www.advancecareplanning.ca/resource/acp-day-campaign-kit-2020/).Please provide your Organization/Facility and contact informationName First Last OrganizationAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email PhoneOrganization Type Regional Health Authority Hospital Medical Clinic Long Term Care Facility Community Based Service Organization Hospice / Hospice Coalition Legal Firm / Organization Funeral Home Professional Association Other Please describe your organizationOther Organization Type: Please SpecifyRole Physicial Nurse Other Health Professional Spiritual Care Worker Administrator / Manager Policy Maker Researcher Educator Volunteer Other What Is Your Role/Profession/Discipline?Other Role (Please Specify):ACP Day Activities Public Workshop Set Up Booth at Community Event Media Interview / Coverage Social Media E-News or Newsletter Staff or Volunteer Training Advocacy / Government Meetings Other Did your organization do any activities to promote advance care planning on the days leading up to or shortly after National Advance Care Planning Day? If the answer is Yes, please describe your activities. If you held activities not covered in the list, please describe them below. below.DescriptionResources Workbook / Quick Guides Framework Public Legal Toolkit Lawyer Legal Toolkit Posters / Pamphlets Wallet Cards Bookmarks Videos Presentation Slides Template Emails, Blogs, or News Releases Conversation Starters Social Media Messages None of the Above Other Which Speak Up resources did you use (if any) during your activities?Other Resources (Please Specify):OverallPoorFairGoodVery GoodExcellentHow satisfied were you with the campaign resources provided by 'Speak Up' for ACP Day?Future ImprovementHow can the Speak Up ACP Day campaign better support you in your ACP activities?GapsWas there anything missing from this year's campaign?Past HistoryI have not participated1-2 Years3-5 Years>5 YearsHow many years have you participated in National Advance Care Planning Day?Involvement A provincial/territorial Palliative Care or Advance Care Planning Community of Practice? The national ACP Educators Community of Practice? The national ACP Champions contact list? On the 'Speak Up' monthly mailing list? Other Are you involved in any of the following? (Check all that apply)Other Involvement (please specify):Future Involvement A provincial/territorial Palliative Care or Advance Care Planning Community of Practice? The national ACP Educators Community of Practice? The national ACP Champions contact list? On the 'Speak Up' monthly mailing list? Would you like to be involved in any of the following? (Check all that apply). We will follow up with you with more information about these groups if you are interested.CommentsDo you have any other comments about ACP Day?Thank you for your time and ongoing promotion of advance care planning!NameThis field is for validation purposes and should be left unchanged.
