Introduction A diagnosis of advanced cancer has a profound impact on the whole family. However, research has mainly focused on patient and carers needs or short-term interventions; with little emphasis on their own coping strategies or the wider impact on health.

Aim(s) and method(s) 27 semi-structured interviews were conducted with patients with advanced breast, colorectal or lung cancer and their close relatives. Questions focused on their experiences, coping strategies and the impact of these on cancer beliefs and attitudes. Interviews were transcribed verbatim and data analysed using the constant comparison method.

Results Patients had more positive attitudes to cancer than relatives, whilst adapting to and accepting dying. They described multiple approaches to coping which centred on regaining control. These included seeking and accessing information, adopting positive attitudes to living with progressive disease, increasing connectedness to their loved ones and leaving a legacy. A legacy was often a hope that their situation would positively impact on others in the future. Relatives, in contrast, described multiple levels of fear and helplessness, which led to strongly fatalistic beliefs about cancer and cancer information avoidance, in spite of an increasing perception of their own vulnerability.

Conclusions A health promoting approach to palliative care, based on supporting self-management and empowering patients' own coping strategies, could have multiple benefits. These may include reducing fatalistic beliefs about cancer, which are associated with lack of receptivity to cancer prevention messages and delayed diagnosis.