Communication Assessment Guide: Appendix 3

Results Template

Name: ___________________________________  ID#: _______________________  Date: _____________________

Part I: Role Impressions Tasks

  1. Impression of Liked Other:

    [Insert original participant response here]

    Total Number of Concepts: ____________________

  1. Impression of Disliked Other:

    [Insert original participant response here]

    Total Number of Concepts: ____________________

 

Part I: Total Number of Concepts (A+B): ____________________

 

Percentile rank (Calculate if scoring a group of participant responses): ________________

 

Part II: Role Scenarios Tasks

 

  1. Response to Non-Clinical Group Project Situation:

    [Insert original participant response here]

    Category: ____________________

  1. Response to Disclosure Situation, Immediately After Event:

    [Insert original participant response here]

    Category: ____________________

Return to Contents
Proceed to Appendix 4

Return to CANDOR Contents

Page last reviewed February 2017
Page originally created April 2016
Internet Citation: Communication Assessment Guide: Appendix 3. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5-guide-ap3.html