by Amanda Roberts and Kirstie Pollard – Three years ago, Amanda published an article in e-hospice (Roberts, 2023), discussing how the PATCHATT (Patients Changing Things Together) programme helped people with a life-limiting illness to make a difference to something which mattered to them.
Through facilitated workshops, participants were supported to take the initiative, plan for a small change and take action themselves to make change happen (Roberts, 2024).
The PATCHATT programme was evaluated in 2024 under the auspices of the University of Hertfordshire. Birckmayer and Weiss (2000) argue persuasively that evaluation is only useful if it is grounded in a programme’s underlying theory and intended outcomes. The evaluation concluded that an overly complex programme design hindered the fulfilment of PATCHATT’s aims. We therefore refined our aspirations and developed new projects, including The Circle of Life.
Like PATCHATT, the Circle of Life project is grounded in support for human agency – our ability to change things for ourselves and others (Bandura, 1977). However, it has a broader scope, supporting people at any stage of life to reflect on their past and present and consider what will matter to them in the future. This developing understanding is seen as a first step towards more formal Advance Care Planning.
An Advance Care Plan (ACP) specifies the care an individual would like in the future including at the end of life. The Marie Curie website (2025) underlines ACP’s particular value if people lose the capacity to convey their wishes. However, few of us have made any formal plans to guide what happens when we become very unwell. Open conversations led by St Christopher’s Hospice (2024) found that 70% of UK adults had never heard of an Advance Care Plan and just 3% had one. We all want to live and die well. The World Health Organisation (2025) recommend we achieve this through developing our healthcare capacities at each stage of life. Developing the skills, confidence and emotional resilience to have conversations about end-of-life preferences is a key healthcare capacity. The Circle of Life project provides a simple structure to normalise such conversations
Circle of Life project participants attend two, 2-hour workshops, designed to help them to:
- understand death as a natural part of life
- think about who they are now and how this might change in the future
- live their lives well, though developing a deeper understanding of what matters to them
- maintain control of their lives through planning for the future, including for the end of life
- talk more openly about their wishes with family members and healthcare professionals, using their Circle of Life to prompt conversations or as part of more formal ACP processes
In workshops, participants are provided with a large paper copy of a blank Circle of Life. The circle is divided into quadrants, with headings echoing the four seasons. This circle acts as a structure for reflection. Facilitators encourage participants to tell stories of early childhood (Spring), early adulthood (Summer) and their present lives (Autumn). They reflect on what has been important to them and what it has meant for them to live well. They begin to explore their wishes for the final part of their life, Winter, to answer the question, what do you think will matter to you in the future, as the end of your life approaches?
Facilitators encourage participants to express their ideas through abstract drawings, including simple comic-style stick figures with speech bubbles to show dialogue or thoughts. Using visual imagery in their Circle of Life allows participants to express feelings and understandings too difficult to put into words (Woods, 2011). This is a technique regularly used in medicine to communicate patients’ experience of illness (Wombles, 2021) and to promote patient agency, helping them plan for change (Venkatesan and Saji, 2021). An example of a completed Circle of Life is given in lead photo.
We are currently piloting the Circle of Life project. Early indications are that it facilitates individual reflection and enhances agency, helping participants to explore and share what matters to them as a unique individual. Whilst the pilot is with older adults, we see the project’s future value as an upstream public health intervention. Here, it could be used across the life course to support individuals in ongoing, proactive health planning.
If you see this as a potentially useful intervention with individuals/groups within your service, please connect with us/join the pilot.
Contact:
Amanda Roberts, Director of BEING MORTAL
https://www.patchatt.co.uk/circleoflife
==============
References
Bandura, A. (1977) Self-efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review,84(2), 191-215.
Birckmayer J. and Weiss, C. (2000) Theory-based evaluation in practice: What do we learn? Evaluation Review, 24 (4), 407-431.
Marie-Curie (2025) Planning your care in advance. Available at: Advance care planning | Gold Standard Framework | Marie Curie (Accessed: 4 March 2026).
Roberts, A. (2024) Scaffolding patient agency: conceptualising readers’ cognitive work in the comic gutter. Health. Available at: Scaffolding patient agency: Conceptualising readers’ cognitive work in the comic gutter – Amanda Roberts, 2024 (Accessed: 15 March, 2024).
Roberts, A. (2023) Beyond ‘what matters to you?’ – patients changing things together. Available at: https://ehospice.com/uk_posts/beyond-what-matters-to-you-patients-changing-things-together-the-patchatt-initiative/#:~:text=PATCHATT%20supports%20group%20members%20to,’What%20matters%20to%20you? (Accessed: 14 March 2026).
St. Christopher’s Hospice (2024) 2024: Our highlights from the year. Available at: https://www.stchristophers.org.uk/2024-our-highlights-from-the-year/ (Accessed: 16 March 2026).
Venkatesan, S. and Saji, S. (2016) Rhetorics of the Visual: Graphic Medicine, comics and its affordances. Rupkatha Journal on Interdisciplinary Studies in Humanities, VIII (3). Available at: https://rupkatha.com/graphic-medicine/ (Accessed: 16 March, 2026).
Wombles C. (2021) Graphic Medicine: Comics as a Patient Education Resource Journal of Consumer Health on the Internet, 25:3, 310-318.
Woods, A. (2011). The limits of narrative: provocations for the Medical Humanities. Medical Humanities, 37, 73-78.
World Health Organization (WHO) (2025) Framework to implement a life course approach in practice. Available at: https://www.who.int/publications/i/item/9789240112575 (Accessed: 27 February 2026).
Leave a Reply