Hospice Trends

National study provides great marketing data

Study in JAMA shows you have what they want

By Eric Resultan
Editor, Hospice Management Advisor

Left to die in nursing homes and hospitals, terminal patients and their families are largely underserved. Hospices, on the other hand, provide a variety of services that meet the needs of the terminally ill and their families. That, in a few words, is what a recent study published in the Journal of the American Medical Association (JAMA) found.

Specifically, researchers concluded that dying Americans receive inadequate pain management, little emotional support, and poor communication from their physicians. Hospice care at home provides greater levels of satisfaction and fewer problems with pain management, the study concludes. The national study by researchers from Brown University was published in the Jan. 7 issue of JAMA (2004; 291:88-93).

From an academic perspective, the results suggest that people dying in institutions would be better served by hospices where specialized end-of-life care services can be provided. For hospice leaders, the findings of the JAMA study are no real surprise. Step back, though, and look at the study outside of its academic perspective. Think of it as marketing research that points out the market advantage that hospices have over the competition. First, let’s look at the study itself and what it tells us about hospice, its competitors, and consumer demands.

Study findings

Key findings from the report include:

  • One in four people who died did not receive enough pain medication. This was 1.6 times more likely to be a concern in a nursing home than in hospice at home.
  • One in two patients did not receive enough emotional support. This was 1.3 times more likely to be the case in an institution than in hospice.
  • Twenty-one percent of respondents complained that the dying person was not always treated with respect. Compared with hospice, this proportion was 2.6 times higher in a nursing home and 3 times higher in a hospital.
  • One in four respondents expressed concern over physician communication and treatment decisions.
  • One in three respondents said family members did not receive enough emotional support.
  • Respondents whose loved ones received hospice in a home setting were the most satisfied. More than 70% rated hospice care as excellent. Fewer than 50% gave that grade to nursing homes or home health services.

The study stated that "high-quality end-of-life care results when health care professionals (1) ensure desired physical comfort and emotional support, (2) promote shared decision making, (3) treat the dying person with respect, (4) provide information and emotional support to family members, and (5) coordinate care across settings."

According to the National Hospice and Palliative Care Organization in Alexandria, VA, "These characteristics of quality end-of-life care are integral to the interdisciplinary hospice philosophy of care."

"The results of this survey attest to the continued need to improve the quality of care for seriously ill and dying persons," says the study’s lead author, Joan M. Teno, MD, professor of community health and medicine at Brown.

You have what consumers want

There it is. The very things that are hallmarks of hospice care are the same things that consumers told researchers they felt contributed to a high-quality end-of-life experience. In other words, the five points listed above are distinct market advantages hospices have over their competitors.

Health care organizations, hospices included, are no different from any other business in a free-market economic system. You must develop a marketing plan that provides a competitive advantage. So what is a competitive advantage? It is anything that makes you better than your competitor. For example, McDonald’s has a competitive advantage over most other fast-food chains because they have more restaurants than the competition. Delta Airlines has more non-stop flights to New York City from most major cities than other carriers. The Mayo Clinic has a brand recognition that is synonymous with quality health care.

Given this principle, hospices have the following market advantages over hospitals and nursing homes:

Providing physical and emotional support. Pain management, counseling, and spiritual care are services that have defined hospice, yet local and national efforts have yet to successfully market this point to a degree that has changed consumers’ habits. Hospitals and nursing homes, on the hand, have a great deal of negative baggage attached to caring for the terminally ill. So, this market advantage actually presents two opportunities: one, promote the benefits of palliative care; and two, seize upon consumer dissatisfaction with other care options.

Promoting shared decision-making. For many patients, losing control is a real issue. From the time they are diagnosed with terminal illness, there is a sense that treatment decisions are made for them. Choosing to die rather than continuing with futile treatment is often the single choice they get to make during the curative phase of their illness.

A greater role in treatment decisions

Time and again, consumers tell the health care community they want more options and the power to choose the kind of care they receive. For instance, women revolutionized how they gave birth a generation ago. Their desire to have their spouses in the delivery room and better prenatal care gave rise to birthing centers and women’s health centers. Consumers are now telling the health care industry that they want to play a greater role in treatment decisions when they are diagnosed with a potentially life-limiting illness. For hospice, this means getting more involved in the disease process sooner and showing consumers they do have a choice. Hospices also must do a better job communicating to consumers just how prominent a role they play in their hospice care and how hospice workers help communicate treatment options.

Respecting the patient. The fact that consumers feel slighted by physicians and nurses in non-hospice settings speaks volumes. It shouts loudly at hospices to take advantage of consumer dissatisfaction. It does not mean denigrating other health care professionals, but hospices, especially those that gather patient/ family satisfaction data, can market their success in this arena. For example, a public campaign can make use of testimonials in which family members of hospice patients share their positive experience or how the patient’s quality of life improved when they were taken from an institutional setting and allowed to return home to die.

Supporting family members. It can be said that hospice care is as much caring for the family as it is for the patient. The issues of family and patient are so intertwined that it would be ineffective to treat one without considering the other. Bereavement programs are also a unique benefit that can only be found in hospice. On the other hand, a consistent complaint of families whose loved one is in a hospital or nursing home is the unresponsiveness of physicians and nurses when they have concerns or a need for information.

Hospices must promote the following services to show how they support family members:

  • bereavement care;
  • spiritual care for both patient and family;
  • identification and connection to community services to assist caregivers;
  • 24-hour on-call nursing services to assist caregivers in emergencies;
  • coordination of care across health care settings.

Clear up misunderstandings about hospice

One the biggest hurdles hospices face is a lack of understanding. People have long misunderstood what hospice care entails, such as believing it’s a place where people go to die, where doctors and nurse practice euthanasia, where you only go when you have no other options or when you’ve lost hope, and so on.

First, hospices must do a better job of communicating what their services entail and debunking myths about hospice. Make sure consumers in your area understand that hospice tries to serve patients where they feel most comfortable, which for most people is at home, among family and friends. Yet people need to know that hospice care is available to them no matter where they reside, and that hospices are capable of coordinating their care even though they are a nursing home patient or in an intensive care unit bed.

It is important to remember that all these factors are market advantages only if consumers believe them to be so. If a physician practice’s marketing plan relies on the marketing advantage of having the "best doctors," the advantage is lost if the market itself doesn’t recognize this point.

In many ways, hospices are in a situation in which they must drive demand. Until consumer habits change and hospice care is a commonly known health care option, this will remain true. So, it is incumbent upon hospices to not only communicate these market advantages, but to explain why these elements should be seen as qualities missing from health care in the area.

Also, developing a strategy that will bring market advantages is only as good as the advantages themselves. In other words, if a factor ceases being a market advantage, then you’ve lost ground to your competition. Failing to communicate your advantages to consumers in the face of competition only buys your competitors time to retool their product and position themselves to seize upon what was once yours.