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BackgroundMany patients with incurable cancer are expected to live for a considerable period of time, yet with the knowledge of their disease's inevitable end-of-life outcome. This duality can lead to existential concerns. A single one-hour meaning-making conversation was developed in which a patient explores their sources of meaning together with a spiritual counselor.AimTo explore how patients experience and benefit from a conversation aimed at supporting meaning-making, in order to inform further refinement of this intervention.DesignWe conducted a formative mixed method pilot study. Evaluation interviews assessed patients' experience and reported benefits. A reflexive thematic analysis was conducted. Key themes were compared and contrasted by intervention timing and patients' experience of existential concerns. Validated questionnaires were administered to assess patients' existential wellbeing, problems, and needs pre- and post-intervention.Setting/ParticipantsTwenty-one patients with advanced solid malignancies and a prognosis >1 year participated at two different hospitals.ResultsAll patients experiencing existential concerns appreciated the meaning-making conversation and reported benefits, such as reflection, validation, insight and actions related to sources of meaning. Half of the those not experiencing existential concerns reported no benefits, and some reported a negative experience. Quantitative data suggest a decrease in most existential problems and needs post-intervention. Existential wellbeing increased post-intervention.ConclusionsA meaning-making conversation can support the process of meaning-making for patients living long-term with incurable cancer. Refinement of the intervention should focus on targeting patients experiencing existential concerns.