Target your marketing efforts at consumers

Focus on the public as well as professionals

For years, hospices have directed their marketing efforts at referral sources and other professionals who can persuade dying patients that hospices offer the best care for their terminal illnesses. But one Massachusetts hospice organization says hospices must expand their focus to include consumers.

Rather than relying solely on doctors, discharge planners, case mangers, and ministers to affect hospice admissions, hospices should target consumers with a multimedia public awareness campaign to put them in a position to drive the demand for hospice care.

"Rather than focusing on just the professional model, we also used the maternity model that focused on women," says D. Rigney Cunningham, MSW, executive director of Hospice & Palliative Care Federation of Massachusetts in Norwood. "We felt that if we could take public support in the same way mothers changed maternity care, those with terminal illnesses could begin demanding hospice care."

In 1998, the Hospice & Palliative Care Federation embarked on a public awareness campaign, called Choosing Hospice, funded by a grant from the Robert Wood Johnson Foundation. The project built upon a 1996 Boston Globe supplement on hospice care and the growing discussion about end-of-life care.

Specifically, the project employed the following strategies:

• reprinted 107,000 copies of the Boston Globe supplement, which was originally published in June 1996;

• developed three public service announcements about hospice;

• published and distributed a hospice consumer guide;

• assembled a photography exhibit from photos taken for the Boston Globe supplement for use in community locations such as libraries, schools, hospitals, and museums;

• produced a 10-minute documentary film on hospice that can be used in conjunction with a speakers’ bureau.

In short, Cunningham says, the federation set out to raise public awareness of hospice by implementing a multimedia approach. The hope was to create a model campaign that would raise awareness throughout the state with components that local hospices could use to raise awareness in their own communities.

"About a quarter of hospices have the resources to employ their own public relations, while the rest are unable to have someone focus on public awareness," says Cunningham. "We felt these hospices didn’t have the expertise to raise public awareness in a time when end-of-life care was hitting the forefront."

The project was completed in 1999. Nearly two years removed, Cunningham has the benefit of time to look back at what worked and what didn’t and offers her recommendations for hospices seeking to bolster hospice recognition in their own community.

"The model developed at the state level with dissemination at the community level was successful in creating high-quality and cost-effective public awareness," says Cunningham.

Group utilized reprinted newspaper stories

The written word was the foundation of the federation’s public awareness campaign. Rather than trying to create a moving piece that embodied all that makes hospice care unique among health care, the federation received permission from the Boston Globe to reprint 107,000 copies of the Pulitzer Prize-nominated package of stories and photos.

Thirty-eight of 47 hospices in Massachusetts requested copies, ranging from as few as 100 to as many as 1,000. Hospices handed them out to physicians during conferences, grand rounds, and training sessions, as well as to lawmakers and the public during health fairs. Copies also were given to hospice volunteers, board members, donors, and new employees.

In addition to the reprinted newspaper stories, the federation produced a 16-page consumer handbook, which made it easier for hospices to engage the public in a uniform fashion, ensuring the public received a consistent message.

The guidebook, Choosing Hospice: A Guide to Hospice Care in Massachusetts, covered the following topics:

• eligibility;

• why consumers should choose hospice;

• where care is provided;

• frequently asked patient questions;

• frequently asked family questions;

• financial arrangements, insurance coverage, and Medicare;

• reimbursement;

• resources.

Participating hospices were given 150 copies
of the handbook free of charge. In addition, a CD-ROM version of the guidelines was offered, which allowed hospices to customize the guidelines to
fit their individual organizations and print the guidelines at their own cost. Beyond the first free 150 copies each hospice received, hospices were responsible for the cost of additional reprints.

Sample press releases and public service announcements were made available to hospices to aid them in promoting the guidelines to consumers through local newspapers.

Both the newspaper supplement and guidelines were also distributed via a direct mail campaign that targeted all the usual professionals — HMO case managers and hospital discharge planners — because of their potential to refer patients to hospice.

To affect public awareness, the guidelines were sent to all 250 Massachusetts state legislators and to long-term care facilities. The newspaper supplement was mailed to colleges and universities, community clergy, and hospital chaplains in hopes they would be used as a teaching tool.

Aside from the stories contained in the Boston Globe supplement, the photos that accompanied the project were equally compelling. Using the published photos, as well as some that were not published, the federation created two 20-photo exhibits. Hospices were allowed to borrow the exhibit as part of their own public awareness efforts.

The photo exhibit was most commonly shown in public buildings, such as a post office or public library, and at educational conferences. In February 1999, the exhibit was used in conjunction with the release of the U.S. postage stamp that honored hospice care.

The exhibit allowed hospice to reach people who may never have considered hospice as a possible part of their distant future. Few hospices took advantage of the exhibit, Cunningham says. Of the 10 hospices that used the exhibit, all were enthusiastic supporters of it as a public awareness tool.

No visual approach would be complete without a video. Following the release of the Boston Globe supplement, New England Cable Network produced a one-hour television show featuring Nora Lenihan, a 40-year-old cancer patient who was featured in the Globe project. The federation received permission to re-edit the program to reduce its running time to 28 minutes. The video was used as a community education tool by 42 hospices.

In addition to the media mentioned above, the federation also employed the following:

• an Internet web page,, as a means of further educating the public;

• public service announcements;

• speaker’s bureau;

• print advertising.

The bottom line for Massachusetts hospices has been a 15% growth in hospice admissions. While Cunningham says the public awareness campaign cannot take complete credit for the increase, she believes the project played a large role. The debate surrounding end-of-life care and euthanasia, and Bill Moyer’s "On Our Own Terms" series, were instrumental in getting hospice care to register on the radar screens of Massachusetts consumers.

While most items had some degree of success, Cunningham says the public service ads yielded disappointing results because the demand for television time usually relegated the ads to early-morning spots when most people were asleep. Also, technology-related approaches did not fare well. For example, the CD offered to hospices that would have allowed them to customize the consumer guidelines did not succeed because most hospices did not own the expensive publishing program needed to complete the project.

The lesson of the project, says Cunningham, is for hospices to shed old notions of how to raise public awareness. While physicians, discharge planners, nursing homes, and long-term care facilities should remain key targets of education and information, the public should not be ignored. Cunningham is an advocate of addressing consumers directly in hopes of prompting health care consumers to shape their own end-of-life care.

"What we tried to do was to present hospice as a brand name," Cunningham says.