Background For many, a cancer diagnosis signals death’s inevitability and elicits existential concern. In the quest for life prolongation, patients seek futile life-sustaining treatments, fail to appreciate a declining trajectory and lack the opportunity to seek information or plan meaningfully for their future. Advance care planning (ACP) is a process that supports adults at any age or stage of health to plan for future care through an understanding and sharing of personal values, life goals and preferences. An increased emphasis is now placed on exploring personal values to ensure alignment with the choices made relating to treatment and end-of-life desirables. Interventions that incorporate a values-based paradigm remain underdeveloped.

Method Using a multi-method research design, we developed a novel intervention using the video vignette technique and incorporated the dyadic approach to examine participants’ perceptions, beliefs and attitudes. A randomised controlled trial formed the analytical core of this study, with a secondary qualitative component. Cancer patient-caregiver dyads were randomised to a values-based video vignette intervention or usual care. We hypothesised that those exposed to the video intervention would be more likely to complete an ACP.

Results One hundred and thirteen cancer patient-caregiver dyads were recruited and randomised. Our findings described older participants as more likely to identify with values. Furthermore, we highlight that the mutuality of dyadic relationships in care planning may be conceptualised at three levels: communication, reciprocal influence and patient-caregiver congruence. In eliciting personal values, cancer patients concurrently postured stances of vulnerability and resilience, in keeping with conflicting emotions and experiences. Equanimity in the cancer patient was apparent with acceptance of frailty and finitude of life, sustained benevolence to others and the use of ritual at the end-of-life.

Conclusion We highlight that ACP requires contextualisation of individual situations and values and should focus on achieving meaningful outcomes beyond completing documents.