The Hospice and Palliative Care Community Finds a New Digital Home on Bluesky

The landscape of online professional communities, particularly within specialized fields like hospice and palliative medicine, is in constant flux. For years, platforms like Twitter served as a central hub for professionals to connect, share information, and engage in discourse. However, a significant shift is underway, with many professionals, including prominent figures in the hospice and palliative care (HAPC) community, migrating to newer, text-based platforms. This article explores the reasons behind this migration, the emergence of Bluesky as a favored alternative, and the implications for the future of online professional networking in this critical medical specialty.

A Shifting Digital Landscape: From Twitter’s Heyday to Present Discontent

Christian Sinclair, MD, FAAHPM, a respected palliative care physician and editor-in-chief of Pallimed, a leading online resource for hospice and palliative medicine, articulated a sentiment shared by many in his field: a growing disillusionment with the direction of Twitter. In a recent post, Sinclair openly stated his personal departure from the platform, citing "multiple reasons" that rendered it no longer a "good site." This personal decision reflects a broader trend, as numerous professionals have expressed similar concerns regarding content moderation, algorithmic changes, and a perceived decline in the quality of discourse on Twitter.

Sinclair’s earlier advocacy for Twitter in February 2009, as documented on Pallimed, highlights how the platform once served as a valuable tool for community building and information dissemination. At its zenith, Twitter facilitated rapid communication, allowed for the sharing of research findings, and fostered a sense of camaraderie among HAPC professionals. The ability to engage in real-time discussions, follow key opinion leaders, and access timely updates on conferences and policy changes made it an indispensable asset. However, the platform’s evolution, particularly in recent years, has eroded these benefits for many users.

Bluesky Emerges as a Promising Alternative

In the wake of dissatisfaction with established platforms, a new contender, Bluesky, has captured the attention of the HAPC community. Described by Sinclair as a "text-based microblogging platform," Bluesky is being heralded as a refreshing and collegial online space. Its appeal lies in its perceived simplicity, its focus on text-based communication, and a more curated environment that fosters genuine interaction.

Sinclair, who has been an active user of Bluesky for 18 months, notes a significant surge in activity and quality of content on the platform in recent times. This growth is not confined to the HAPC community alone; it extends to a broader medical professional contingent migrating from Twitter, alongside newsmakers, entertainers, academic journals, and medical societies. This influx suggests a widespread recognition of Bluesky’s potential as a viable alternative for professional networking and information exchange.

Key Features Driving Bluesky Adoption

Several key features contribute to Bluesky’s growing popularity within the HAPC sector:

• Focus on Community and Collegiality: Users frequently describe Bluesky as "fun, light, and collegial," fostering an environment where professionals feel comfortable engaging and collaborating. This atmosphere is particularly valuable in a field that often deals with sensitive and emotionally charged topics, where supportive professional networks are crucial.
• Absence of Advertisements (Currently): The current ad-free nature of Bluesky is a significant draw for users seeking an uncluttered and focused online experience. This contrasts sharply with platforms increasingly dominated by commercial interests, which can detract from professional content and user engagement.
• Robust Discovery Tools: Bluesky offers features designed to help users find content and individuals relevant to their interests. This is essential for navigating the growing volume of information and connecting with like-minded professionals.
• Enhanced User Protection: The platform incorporates tools aimed at protecting users from harassment and unwanted content, contributing to a safer and more productive online environment. This is a critical consideration for professionals in any field, but particularly for those in healthcare who may be subject to public scrutiny.
• Community-Driven Starter Packs: A unique feature of Bluesky is the ability for users to create and share "starter packs" – curated lists of accounts to follow within specific communities. Sinclair has developed a "Hospice and Palliative Care People starter pack" containing over 120 individuals dedicated to palliative care. Similarly, Catherine Walshe, editor of Palliative Medicine, has created another valuable HAPC starter pack. These initiatives streamline the onboarding process for new users and facilitate immediate community integration.
• Potential for Early 2010s Twitter Vibe: For those who recall the early days of Twitter, characterized by strong community bonds and genuine interaction, Bluesky offers a similar experience. This nostalgic appeal, combined with the platform’s current trajectory, is attracting users seeking to recapture that sense of digital camaraderie.

The Decline of Other Platforms

Sinclair’s analysis also touches upon the shortcomings of other potential alternatives, further solidifying Bluesky’s position:

• Threads: While initially promising, Threads is criticized for a "broken algorithm" and a heavy emphasis on brands, making it less appealing for niche professional communities.
• TikTok and Instagram: These platforms are primarily visual and video-centric, not aligning with the needs of professionals who primarily engage through text-based discussions and information sharing.
• Facebook: Perceived as "tired" and less conducive to professional networking, Facebook has lost its appeal for many seeking dynamic online communities.

This comparative assessment underscores the specific niche that Bluesky appears poised to fill for the HAPC community and potentially other professional groups.

Timeline of the Digital Migration

The migration from Twitter to alternative platforms is not a singular event but rather a gradual process that has gained momentum.

• Early 2009: Christian Sinclair advocates for Twitter as a valuable tool for the HAPC community on Pallimed.
• Mid-2010s: Twitter experiences peak engagement for professional communities, facilitating rapid information sharing and networking.
• Late 2010s – Early 2020s: Increasing concerns arise regarding Twitter’s evolving policies, algorithmic changes, and the quality of discourse.
• 2021-2023: A growing number of professionals begin to explore and migrate to alternative platforms, including emerging decentralized social media initiatives.
• Early 2023: Bluesky, initially in beta, begins to attract attention from various professional groups.
• Mid-2023 – Present: Bluesky experiences a significant surge in user adoption, with a notable influx of medical professionals, including those from the HAPC community, driven by dissatisfaction with Twitter. Sinclair himself joins Bluesky approximately 18 months prior to his recent post and notes a substantial uptick in HAPC activity on the platform in the past weekend.

Implications for the Hospice and Palliative Care Community

The migration to Bluesky carries significant implications for the future of professional engagement in hospice and palliative care:

• Enhanced Collaboration and Knowledge Sharing: A concentrated and engaged community on Bluesky can lead to more robust discussions, collaborative projects, and faster dissemination of best practices and research findings. This is particularly vital in a field that is continuously evolving and requires up-to-date knowledge.
• Strengthened Professional Networks: The collegial atmosphere of Bluesky can foster stronger professional relationships, mentorship opportunities, and a greater sense of support among HAPC providers who often face challenging work environments.
• Increased Visibility for the Field: A unified online presence can amplify the voice of the HAPC community, raising awareness about its importance, advocating for policy changes, and educating the public.
• Potential for Future Innovations: As the community coalesces on Bluesky, there is potential for the development of new tools and initiatives tailored to the specific needs of HAPC professionals. Sinclair’s hosting of weekly #hapc chats (formerly #hpm chats) on Wednesday evenings is an example of such community-driven engagement.
• Dissemination of Information about Key Events: Bluesky is being utilized as a platform for disseminating information about crucial events, such as the upcoming Annual Assembly #HAPC25 in Denver, further centralizing important announcements and discussions.

Looking Ahead: The Future of Online Professional Discourse

The shift from established social media giants to newer, more specialized platforms reflects a broader trend in how professionals seek to connect and communicate online. For the hospice and palliative care community, the move to Bluesky appears to be driven by a desire for a more focused, less commercialized, and genuinely collegial digital space. As Sinclair’s initiative to host weekly chats and share starter packs demonstrates, the community is actively shaping its presence on this new platform.

The long-term success of Bluesky will depend on its ability to maintain its current trajectory, continue to foster a positive user experience, and adapt to the evolving needs of its growing community. For Pallimed and its readership, this digital migration may also signal a renewed opportunity to re-engage with the platform and its vital contributions to the field of hospice and palliative medicine. The question of whether "we are back" in terms of online community engagement might well be answered by the continued growth and vibrancy of platforms like Bluesky.

Christian Sinclair, MD, FAAHPM, is a palliative care physician at the University of Kansas Health System and editor-in-chief of Pallimed. He has been an active advocate for the use of social media in professional medical communities.