Unfacilitated writing activities, such as expressive writing, have not shown benefit in people with advanced cancer, but facilitated writing activities have yet to be fully explored. To assess the feasibility and acceptability of facilitated writing activities determined by a writing coach in people with advanced incurable cancer. This is a single-arm pilot study. Adult patients with advanced incurable solid malignancies from a U.S. rural comprehensive cancer program met with a writing coach monthly for at least three months for facilitated writing activities. Feasibility was assessed by enrollment and postinclusion attrition rate. Acceptability was assessed by (1) <15% drop out rate due to the intervention, (2) <15% elevated anxiety or depression due to the intervention, and (3) patient qualitative comments. In total, 22 out of 63 patients consented (35%). Postinclusion attrition rate was 18% ( = 4) at three months with 82% completing at least three months of the writing coach intervention. No participants dropped out or had elevated anxiety/depression due to the intervention. The majority of patients wanted the whole intervention continued. A writing coach using facilitated writing activities was feasible and acceptable in patients with advanced incurable cancer, but further studies are needed to assess impact. Clinical Trial Registration Number NCT 025 75898.