Monday, December 4, 2017

National Hospice and Palliative Care Month: Divide and Conquer

by Christian Sinclair (@ctsinclair)

Now that National Hospice and Palliative Care Month (NHPCM) is in the books for 2017, December is a good time to reflect on what these awareness months can (and cannot) accomplish and how we can make a better strategy for the future. Awareness campaigns have blazed brightly through the bracelet and ribbon eras, and are firmly in the social media era with no signs of stopping (other than possibly fatigue from so much awareness about awareness campaigns.)

No single group is technically is in charge of National Hospice and Palliative Care Month. Very few calendar-based advocacy campaigns (CBACs) are trademarked, but there is usually one organization that champions them. Most CBACs get formalized with some sort of political proclamation, like the National Hospice and Palliative Care Organization (NHPCO) (formerly National Hospice Organization (NHO)) did in 1985 with President Ronald Reagan. and Presidents Clinton, Bush, and Obama (not sure if Trump did anything with it this year.) At some point National Hospice Month became NHPCM, probably around the same time NHO became NHPCO in the mid-2000's when palliative care was a growing presence in the health care conversations. NHPCO continues to be the organization which puts the most time and effort into NHPCM as they maintain social media resources, graphics and outreach tools on their website, whereas most other national organizations in hospice and/or palliative care do not.

In 2010, Renee Berry and I created a Facebook Page for National Hospice and Palliative Care Month, because no one else had done so yet. The page has been run as an extension of Pallimed social media as a volunteer effort. Since then the page has featured graphics and posts supporting hospice and palliative care, with most of the efforts centered around November. Messaging for the page has been puzzling over the past few years, and here is my central thesis of this post:

National Hospice Month and National Palliative Care Month need to split up.

Now before any rumors start swirling, I am not calling for any change to the name of the specialty, the name of the fellowship, the names of conferences, the names of organizations (NHPCO, AAHPM, HPNA, SWHPN, etc) or anything like that. But for a public awareness campaign, you need to be narrow and explicit if you expect to get any point across and NHPCM cannot do that when they are combined. I have seen this first hand with both the Facebook Pages of Pallimed and NHPCM.

This year (like years past) I created three different types of graphics with different messaging for hospice only, palliative care only and both hospice and palliative care. As you can see people shared them at different rates, meaning there were some people who were looking for a specific hospice message or specific palliative care message. Take a look at the numbers for the photo frames people could use for their profiles: Hospice (157), Palliative (18), Combined (73). People are looking for specific and unique ways to portray what they do. We should also think the same about the messages we broadcast.


Our message gets muddled during National Hospice and Palliative Care Month. It makes sense to us, because we know what we do every day, but if we are working on awareness then we need to separate, simplify and be direct. In splitting the message between hospice OR palliative care people may see similar messages during the month and then end up equating both approaches, when they are quite different.

Take early access to either hospice or palliative care. With palliative care, the primary message about getting access upstream early in a disease course while people are still getting aggressive treatments long before they may be considered terminal, but with hospice the message about getting access upstream is about seeing people 3-6 months before they die and not 3-6 days or 3-6 weeks. Those patient populations and clinical scenarios are quite different and the key takeaway message is far too nuanced if you try to include them both in any specific campaign.

Another barrier for building awareness and breaking down myths, is having the two types of care jammed against each other separated by a conjunction or an ampersand. This means you can't make short strong statements because you will likely have to do some explaining about Medicare Hospice Benefit rules or the lack of widespread access to palliative care clinics. We waste time explaining the difference or giving equal time instead of sticking on a single message for a single service for a single month.

These challenges noted above shouldn't impact things like the name of the specialty, fellowship, conferences or organizations, because many of the same skills, knowledge and experience is helpful in both parts of hospice and palliative care. Those names are really not about public messaging, but about professional development. There is natural synergy between hospice and palliative care in preparing the workforce of the future. But let's change how we talk about it to the public!

While I am not a marketing professional, I have a proposal to our field. Let's give November back to National Hospice Month exclusively, and pick an upstream month, like May or June for National Palliative Care Month*. With refined messages for the public, they can demand the type of care they deserve to improve their quality of life wherever they are in treatment or goals. Who is with me?

Christian Sinclair, MD, FAAHPM (@ctsinclair) is editor of Pallimed, a former hospice medical director and current outpatient palliative care physician at the University of Kansas Cancer Center. He has a experiential degree in Social Media and Health Care Marketing from the school of life. 

* I keep track of all relevant Hospice and Palliative Care CBACs and anniversaries on a collaborative spreadsheet. (help wanted!) May is a little crowded and overlaps with Australia's Palliative Care week, but also with the UK's Dying Awareness week and Children's Hospice week. June is really pretty empty, and overlaps with nursing assistants's week. So if I had a choice I would pick June.

PS go like our NHPCM page on Facebook

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