Creative Engagement for End-of-Life Conversations – A Stakeholder-Informed Evaluation

Abstract Background Advance Care Planning (ACP) and discussions about death and dying are vital for empowering and enabling individuals to express their preferences and choices regarding future medical care and end-of-life decisions. The Art of Life, a cross-border project, aims to normalise conversations around death and dying through creative approaches. Socially engaged artists deliver interactive workshops using visual language to reach diverse participants. This study aimed to develop a Theory of Change (ToC) to understand stakeholder engagement with the creative processes along with capturing inputs, outputs, and agreed-upon outcomes to establish the impact of the Art of Life project. Methods Three focus groups were conducted with key stakeholders, including creatives, community partners, and workshop end-users. Two in-person focus groups were held in the Republic of Ireland and Northern Ireland, and one online focus group with creatives in November - December 2024. Thematic analysis was used to identify common themes generated from the focus group discussions to gain insights on participants’ experiences. Results Twenty participants took part in the focus group discussions. Key themes included the various activities delivered, stakeholders’ expectations and desired outcomes, wellbeing outcomes, personal growth and professional value for creatives, and challenges and lessons learned. Stakeholders emphasised the importance of the safe, reflective spaces created through creative expression. A ToC was developed to capture the project's inputs, outputs, outcomes, and longer-term impacts. Conclusions This evaluation highlights the potential of the Art of Life project to transform how communities engage with end-of-life conversations. The creative, participatory model fosters emotional resilience, reduces stigma around death and dying conversations, and demonstrates the value of arts-based approaches in public health and community wellbeing. Key messages • Creative approaches can support communities to engage in Advance Care Planning and death and dying conversations through safe, reflective spaces. • A Theory of Change shows that arts-based workshops can foster emotional resilience and improve end-of-life communication in public health settings.