Palliative care providers’ largest referral hurdles have been long-rooted in misunderstandings about their services. Breaking down referral barriers to improve patient access can take vigilant education and outreach efforts.

Among the most common misconceptions about palliative care is that these services are often conflated with hospice as support received at the end of a person’s life. Communicating the differences between palliative and hospice care is not a new plight for providers, but their outreach tactics have evolved as more competitors step into the serious illness space, said Rachel Dedes, senior director of palliative care at NorthStar Care Community.

Clinicians across the continuum lack awareness around the full range of interdisciplinary palliative care services, according to Dedes. Education has become a cornerstone of palliative care providers’ referral-building efforts, she stated.

“Palliative isn’t hospice, you want them to be different programs,” Dedes told Palliative Care News during the Hospice News Sales & Marketing webinar series. “[It’s] lots of education, having relationships with referral sources and letting them know that if they send us a referral we will look and see what they need and get them to the right service. It’s not as important that they can understand exactly the differences.”

NorthStar Care Community provides adult and pediatric home health, hospice and palliative care to more than 6,600 patients across southern Michigan. Recently affiliated with Centrica Care Navigators, the nonprofit organization operates Hospice of Michigan and Arbor Hospice.

The diverse scope of palliative care approaches is a double-edged sword of both opportunity and challenge, according to Dedes.

Palliative care can encompass a range of services that help address physical, emotional, spiritual and psychosocial needs among seriously ill patients. The U.S. Centers for Medicare & Medicaid Services (CMS) defines these services as care that eases symptoms associated with serious illnesses, which may be offered alongside curative treatments.

Supportive care, comfort care and serious illness care are just a few of the common terms that some providers use to describe these services. The dynamic mix of terminology and services that palliative programs can include impacts how patients understand and access this care, according to Dedes.

“Comfort care, while it might add to the confusion on some levels, can also be beneficial, because we’ll have those hard conversations and that’s what we’re good at,” Dedes said. “Comfort care gets them to us, then we can talk with them, hear their story, what their goals are and get them to the right program.”

Around one-third of nurses and roughly two-thirds of physicians reported “good or excellent” knowledge of palliative care in a 2021 study published in the International Journal of Environmental Research and Public Health.

The wide swath of interdisciplinary services can complicate providers’ ability to communicate the value proposition of palliative care among referrals, said Conlee Fisher Clark, director of growth at AMOREM.

“A lot of times people can’t even say ‘palliative,’ much less understand it,” Fisher said during the webinar. “It’s hard for our referral partners to get all the details and they don’t need to. We’re the experts at explaining our services, so that’s how we manage it. It’s constant education, lots and lots of education to everyone all the time.”

North Carolina-based AMOREM provides hospice, palliative, grief support and advance care planning services across 12 counties in its home state.

While education is important, it only goes so far in terms of building referral relationships and avenues for patients to become more aware of their serious illness care options, Fisher stated. Understanding the largest gaps of unmet community needs is key for palliative care providers to know where and how to drive their referral focal points, she added.

Significant to building sustainable care delivery is having marketing and outreach teams who are well-versed in not only the types of palliative services an organization offers, but also the outcomes associated with them, said Fisher.

Palliative care patients are often less likely to seek aggressive and expensive care as their illness progresses, which points to valuable quality, cost and workforce impacts among referrals. This trend is important to communicate with hospitals, emergency medical service and primary care providers, and assisted living and skilled nursing facilities, which represent some of the largest referral avenues, Fisher and Dedes agreed.

“It just depends on your community and asking those questions of how we can be better partners,” Fisher told Palliative Care News. “What are their pain points? See if that’s something your sales team can be phenomenal at in being able to dig down into how to help. You need a good person that understands [their] pain points, understands their business and how to partner with them. That’s crucial. It’s a lot more training than people realize.”