Case study
October 16, 2015

Advocacy Group Aims to Get People Talking — About Death

The Conversation Project
Marla Sax, 65, and her daughter, Jennifer Sax, 35, star in an advocacy campaign The Conversation Project is piloting in the Boston area to get people to discuss their end-of-life wishes.
Ellen Goodman never talked to her late mother about how she wanted to be cared for at the end of her life and was left scrambling when the time came. She improvised treatment and funeral decisions and hoped that she was giving her mother what she wanted.

Ms. Goodman didn’t want other families to go through what she did. And so in 2010 she co-founded the Conversation Project, an advocacy group aimed at helping people talk about and prepare for their final days with the people closest to them. The questions cover treatment choices, religious preferences, type of memorial, and financial issues.

The group has found a widespread hunger for its services. As proof, she points to its Conversation Starter Kit, a free, online guide, translated into eight languages, that has been downloaded more than 250,000 times, from every state and 176 countries since the charity’s website was launched in 2012.

But Ms. Goodman, 74, a Pulitzer Prize-winning journalist with The Boston Globe, wanted to reach a bigger audience.

A public-service campaign aimed at boosting awareness was "always on our dance card," she says. However, the Conversation Project, which runs on a budget of about $650,000, could never get a donor to pay for it.

Until, suddenly, it could.

She and Harriet Stern Warshaw, the project’s executive director, were meeting in the spring of 2014 with a family foundation when its officials asked a question charity leaders dream of: "What would you really like money for?"

Two grants of $100,000 later, the Conversation Project is today launching its first-ever public-service-announcement campaign aimed at coaxing people into having frank conversations about death. (Though Ms. Goodman seeks more candor about perhaps the toughest topic of all, she is tight-lipped about who paid for the campaign, saying the grant makers prefer to remain anonymous.)

"We’ve done this survey that showed that 90 percent of people think having conversations about their end-of-life wishes is important, but only 30 percent have had them," Ms. Goodman says. With the public-service-announcement drive, "we wanted to hit a diverse population and reach people who didn’t usually hear this message."

Keeping It Casual

The campaign, designed by the marketing firm Argus, will pilot over the next six weeks in the Boston area. The ads feature three pairs of real people rather than actors or models — a mother and daughter, a husband and wife, and a pair of young friends. They will appear on bus stops and along three lines of Boston’s subway system.

Despite the tough topic, the ads are inviting, with a warm, autumnal color scheme and candid photos of the people in midconversation. "You tell each other everything," one message reads. "When it comes to end-of-life care, talking matters."

The charity also plans to blast the ads throughout social media, using the hashtag #talkingmatters, and via pop-up online ads; half of the budget will go to such ads. The design will be integrated into the group’s online starter kit; brochures for the campaign will also be distributed to local hospitals.

The Conversation Project is also planning to videotape "man on the street" interviews with passers-by to capture their reaction to the bus and subway ads, to be posted on its website — both to gauge how the ads are being received in different communities but also to add a little fun to the campaign. "It’s serious stuff, but it also has a warm and lighthearted feeling to it," says Ms. Goodman.

The timing takes advantage of families gathering for the coming holiday season but also a change in federal policy: In January, Medicare has proposed to begin paying health-care providers to discuss end-of-life plans with patients. "It’s a real tipping-point moment when there’s going to be a lot of talk about this in the culture," says Ms. Goodman.

Finding the Sweet Spot

Studies show that people who make less than $50,000 a year are the least likely to have discussed such issues with their family members, Ms. Goodman says, and that some ethnic groups are more reluctant to talk about it. To be most effective, the campaign is zeroing in on one key audience. "We knew middle-aged women were our sweet spot," she says. "They are the health-care decision makers in families, and they are the caregivers. And they are the talkers."

The mother and daughter team featured in the first trio of ads, Marla and Jennifer Sax, have been talking about death since Jennifer, now 35, was about 15, says Marla. Both women work for hospices: The elder Ms. Sax, 65, has been a hospice nurse for more than two decades, while her daughter is director of communications at Good Shepherd Community Care, in Newton, Mass.

And yet, Marla Sax says that her mother, now 90, has never been willing to discuss her end-of-life wishes with her. Millennials seem more comfortable having intimate conversations of any kind, including about death, than older generations do, she says. (She notes that Jennifer managed to get her grandmother to talk a bit about her end-of-life wishes after the elder woman was recently hospitalized.)

Going National

The Saxes hope their involvement will persuade people to have these conversations before they need to, a situation they have seen repeatedly in their professional lives. "When you’re having the conversation when you’re in crisis mode, then it’s almost harder, because you’re stressed by a million things — like you’re in pain, and how are we going to pay for this?" says Jennifer Sax.

They also hope such talks lead more people to take a more concrete step: crafting advance directives, the legal documents that spell out an individual’s wishes for end-of-life treatment, giving both family members and medical professionals clear guidance.

The Conversation Project wants to take its campaign national and will look for foundations to help it do so. But first it will test the results in Boston, measuring how many more people come to its website over the six weeks and download its starter kit, how many local medical institutions use its programs — and by, Ms. Goodman says, "that softer metric of buzz."

The crafting of the campaign may hold lessons for other nonprofits that advocate for causes that aren’t easy sells. Talking about end-of-life wishes is "a difficult conversation, but it can also be a warm one," Ms. Goodman notes. "We were conscious of finding a warm, intimate, relational message. Not making it a scary checklist."

"That’s something anyone who wants to encourage hard conversations needs to think about: Not wagging your finger at people but welcoming them into a community of people who are having these conversations."

Send an email to Heather Joslyn.