• Natasha Michael, Xavier Symons, George L Mendz, and David Kissane.
• Supportive, Psychosocial and Palliative Care Research Department (N.M., D.K.), Cabrini Health, VIC Australia; School of Medicine (N.M., G.L.M., D.K.), University of Notre Dame Australia Darlinghurst, NSW, Australia; Faculty of Medicine (N.M., D.K.), Nursing and Health Sciences, Monash University, VIC, Australia. Electronic address: nmichael@cabrini.com.au.
• J Pain Symptom Manage. 2022 Nov 1; 64 (5): 438448438-448.

ContextPersonal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment.ObjectiveTo investigate the diversity of values, experiences and adaptations expressed in cancer patients VDs.MethodsContents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences.ResultsForty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described diverse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs.ConclusionCancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.

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