Attitudes Question Title * 1. What is your gender? Female Male Question Title * 2. What is your age? Under 18 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 3. What is your race? Mark one or more. White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Question Title * 4. Have you had a conversation with a loved one about your own end of life wishes? Yes No Other (please specify) Question Title * 5. Have you had a conversation with a physician about your own end of life wishes? Yes No Other (please specify) Question Title * 6. Do you view any of the following as barriers in discussing end of life wishes with a loved one? (check all that apply) Discomfort on my part Discomfort on the part of another Time Lack of urgency Uncertainty as to what should be discussed Other (please specify) Question Title * 7. Do you view any of the following as barriers in discussing end of life wishes with a physician? (check all that apply) Discomfort on my part Discomfort on the part of the physician Time Lack of urgency Uncertainty as to what should be discussed Other (please specify) Question Title * 8. On a scale of 0 to 10, with 0 being not at all comfortable and 10 being extremely comfortable, indicate your comfort in discussing end of life issues. 0 (not at all comfortable) 1 2 3 4 5 6 7 8 9 10 (extremely comfortable) Other (please specify) Question Title * 9. What is your opinion about media coverage of end of life issues? I think that end of life issues are being discussed a sufficient amount in the media. I think that end of life issues are being discussed too much in the media. I think that end of life issues are not being discussed enough in the media. Other (please specify) Question Title * 10. What do think would enhance comfort in having end of life discussions? Done