Get aggressive with public awareness

Step up PR efforts

In the game of public awareness, if the public doesn’t know who you are or what you’re selling, chances of profitability — not to mention survival — are slim. While much of the hospice industry’s efforts have focused on educating referral sources on the benefits of hospice care and the need for timely referrals, the effort to affect consumer behavior has not received the same level of attention.

Consider this: More than 90% of Americans do not know that hospice care is a fully covered Medicare benefit for patients at the end of life and includes all that Americans say they want for their loved ones, including pain management and emotional support.

Pharmaceutical companies have provided the best example of how an industry can captivate consumers and prompt them to pressure physicians into prescribing drugs that may alleviate symptoms or cure their diseases. Is it possible for hospices to take a page from pharmacy companies’ playbooks to garner the kind of enthusiastic interest that could lead to a greater number of hospice referrals?

The answer, according experts in hospice public relations, is yes and no. Yes, hospices can learn from the consumer-focused approach of drug companies. However, the mass media that inundates television viewers, magazine readers, and radio listeners with promises and images of people unencumbered by disease or debilitating symptoms comes with too expensive a price tag.

In addition, drug companies are able to keep consumers’ attention because most people are comfortable with the notion of using drugs to improve their quality of life. On the other hand, most people are not comfortable with the topic of dying, which could result in a mass media campaign falling on deaf ears and a boondoggle of magnificent proportions.

"It will take a grass-roots effort," says John Millett, a spokesman for the National Hospice and Palliative Care Organization in Alexandria, VA.

Millett says raising public awareness of hospice must begin by pecking away at society’s inability to discuss death. Consumers must be educated via more intimate methods, such as meetings with community groups. Large-scale public awareness should be accomplished through coordinated media campaigns like those done in conjunction with the Bill Moyers public television series On Our Own Terms on death and dying.

Community responsibility

While there are national efforts under way to increase public awareness, hospices must take up the cause of raising awareness in their own communities. The challenges are the same locally as they are nationally. Here are some facts about American’s attitudes toward death and dying:

  • More than one out of every four adults is not likely to discuss with a parent issues related to the other parent’s death, even if the parent was terminally ill and had less than six months to live. Americans are more likely to talk to their children about such sensitive topics as drugs and safe sex.
  • Fewer than 25% of people have thought about how they’d like to be cared for at the end of life and have put it in writing. While 36% say they have told someone about how they would like to be cared for, focus groups show that people often view a passing comment about how they would like to die as informing their loved ones of their wishes.
  • Even though people are not talking about how they want to be cared for during the last stage of life, half of Americans state that they will rely on family and friends to make decisions about care at the end of life.
  • At the same time, people say that making sure that the patient’s own wishes are enforced at the end of life is the most important service available for a loved one who is sick with less than six months to live.
  • About one-third of people are unsure whom to contact to get the best care during life’s last stages; 30% said they would contact their doctor, and 13% mentioned hospice.

"We don’t recognize that they are our public awareness problems, too," says Don Pendley, president of the New Jersey Hospice and Palliative Care Organization in Scotch Plains. For most hospices, public awareness is so weak that most start from the premise that there is a lack of information. To increase public awareness, hospices must promote a strong message that is consistent with other messages being promoted by other hospices or by industry leaders, and the campaign must be ongoing, rather than sporadic.

"If the community doesn’t know you, they aren’t going seek out hospice care," says D. Rigney Cunningham, executive director of the Hospice and Palliative Care Federation of Massachusetts in Norwood.

In 1998, the Hospice and 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. (See related story, Hospice Management Advisor, July 2001)

The project reprinted 107,000 copies of the Boston Globe supplement, developed public service announcements about hospice, published and distributed a hospice consumer guide, assembled a photography exhibit, and produced a 10-minute documentary 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 employ to raise awareness in their own communities.

Similar to the Massachusetts effort, Pendley says the hospice message should focus on how hospice care improves the quality of a patient’s life and how it helps families cope before and after the death of a loved one.

He is skeptical that a blitz of hospice advertising would be cost-effective. But hospices should not be wary of delivering the message to a wider audience. Although most people do not currently need hospice care, the hope is that people will recall the message when the appropriate time comes.

In the end, consumers will determine the success or failure of hospice, both Cunningham and Pendley say. If hospices can affect consumer habits, the care can be elevated in the same manner as maternity services were improved a generation ago by consumer demands.