It’s always too soon to talk, until it’s too late: Advance Care Planning in Powys

Sarah Wheeler, Macmillan Lead Nurse End of Life Care Planning

Powys THB Specialist Palliative Care Team

Powys Teaching Health Board



This project is about facilitating Advance Care Planning (ACP) in a rural community, working in partnership to educate a network of Powys ACP Champions to promote and enable future care planning.

Advance Care Planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future care [1].

82% of people have strong views about their future care, and wish to die in their usual place of residence, surrounded by loved ones. Despite these preferences, in Wales current hospital deaths remain at 50%. Ensuring honest conversations, informed choices, and the involvement of family and carers allows for coordinated care based on the values, beliefs and wishes of the person at the end of their life.

Rural communities such as Powys face additional challenges, as residences are often far from hospitals and loved ones, making planning ahead especially important for ensuring quality palliative and end of life care. Although these are often seen as difficult conversations, evidence suggests that ACP is more accessible and less threatening in rural areas when these conversations are held with local people.

In 2019, the Powys Specialist Palliative Care Team launched the PTHB “My Life, My Wishes” Advance Care Plan document and guidance booklet, following extensive key stakeholder and public engagement. This project trains ACP champions from health, social care and voluntary organisations in Powys to advocate and empower their community to contemplate and share their future care wishes.

Image of a hand holding My Life, My Wishes booklets

Project Aims

The aim was to train Powys ACP champions, who:


Key Outcomes

Image of some of the Powys ACP champions
Image: a photograph of some of the Powys ACP champions
A graph showing the improved levels of knowledge, skills and confidence ACP champions felt after training.
A graph showing the improved levels of knowledge, skills and confidence ACP champions felt after training.

ITV News Wales report on the Powys pop-up Departure Lounge event

Next Steps

We have educated Powys ACP Champions in our rural community, and the project is continuing to promote partnership, compassion, care and support from the rural community of Powys for those with greatest need. We will:

The public health message is ACP is for everyone and “it is never too late to discuss your future care wishes.”

Bevan Exemplar Showcase 2021



My Life, My Wishes (Powys Teaching Health Board)


[1] Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel (2017);