Palliative care has only 1% access in India because doctors don’t consider palliative care even when a patient is terminally ill and caregivers just aren’t aware. Hence, both audiences are critical. Among doctors, any doctor involved in the treatment of terminally ill patients in any way became our target audience.

In India, prescription drugs can only be promoted to doctors. This communication is governed under the Drugs and Cosmetics Act and a self-controlled body – ASCI . Doctor-patient communication is also governed by the MCI's ethics policy, which prevents the endorsement of brands but allows unbranded medical information or diagnosis.

We unearthed the insight: Surprisingly, most last words are heard by nurses, not families. This happens because doctors keep even terminally ill patients in ICUs where they do receive the best medical care but are also isolated from their families.

The creative idea: Could these dying last words – so far unheard by families – bring alive the need for palliative care? We interviewed more than 200 nurses across India and the most heart-rending last words they heard became the heart of our campaign – the online video.

The campaign used these real last words to start conversations on palliative care and got doctors to the website that provided detailed information. Doctors were encouraged to make the decision of offering palliative care through online pledges.

200 nurses were interviewed across India and the most heart-rending last words they heard became our film. The film was launched by the Human Rights Commissioner, with hundreds of doctors pledging to offer palliative care to their patients.

Social media became critical to give our campaign the required scale. The real last words were used in the film and in social media posts to start conversations on palliative care. Pre-approved responses to expected queries on the legal, medical and ethical perspectives were kept ready. The clickable video got doctors to the website where they could learn more about palliative care and pledge to offer palliative care.

Palliative care associations across the world were approached to endorse the campaign and strengthen credibility.

The doctor campaign was complemented by a consumer campaign that eventually spanned social and digital media along with PR.

The real last words resonated with doctors and consumers, each sharing personal stories. The campaign even served as a catharsis, with thousands confessing to have missed hearing the last words of their loved ones. Many doctors committed to offer palliative care to their patients, while one even promised to start a palliative care hospital.

The campaign reached a confirmed 50,000+ doctors online. In addition, the majority of Indian doctors were probably reached through the consumer campaign based on the same film. The consumer campaign achieved 100 million impressions and 8 million rupees of unpaid media, even trending at no. 3 on Twitter.

But real success was achieved when international palliative care associations adopted the campaign, as did members of parliament.

The last words are finally being heard.

Palliative care is a category where multiple doctors are involved with multiple opinions. Hence, to achieve significant impact, a majority of the 300,000+ practicing doctors in India had to be reached.

Using a field force to reach doctors was considered, but doctors were uncomfortable discussing palliative care with medical representatives since it has legal, medical and ethical perspectives.

Hence, social media became the choice for media amplification, allowing us to: One, start conversations on palliative care that could drive this cultural change. Two, cost-effectively reach the 100,000 registered doctors on Facebook alone, hence achieving the required scale. Three, support discussions between doctors on the legal, medical and ethical perspectives.

The conversations concluded with a call-to-action to learn more about palliative care on the website, as well as a pledge to offer palliative care to patients.

Palliative care provides comfort and dignity in death. However, even though the Indian Association of Palliative Care (IAPC) has helped establish infrastructure to provide palliative care over the last decade, only 1% of the 6 million eligible Indian patients have access. This happens for two key reasons: One, the Indian medical system focuses on keeping patients alive, even at the cost of pain and suffering. So, even when patients are terminally ill, doctors don’t consider palliative care. Two, consumers just aren’t aware.

Hence, the campaign needed to include doctor and consumer communication with different communication objectives. However, with limited budgets, the concept/execution needed to be similar.

With doctors, driving behaviour change is challenging – they do what they think is best for the terminally ill patient but the campaign had to help them understand how patients are suffering because of lack of access to palliative care.