Purpose <p>This randomized controlled trial aimed to evaluate the effects of a Noddings’ caring theory-based intervention on coping with death competence (CDC), death attitudes, and psychological distress in patients with advanced lung cancer.</p> Methods <p>Seventy inpatients were randomly allocated to the intervention group (<i>n</i> = 35) or the control group (<i>n</i> = 35). The 3-week intervention comprised modeling, dialogue, practice, and recognition phases. Outcomes, including CDC, attitude toward death, anxiety, and depression, were assessed at baseline (T0), post-intervention (T1), and 1-month follow-up (T2).</p> Results <p>No significant between-group differences were observed at baseline. Following the intervention, patients in the intervention group demonstrated significantly higher CDC total and subscale scores, more positive death attitudes, and lower anxiety and depression scores than those in the control group at both post-intervention and 1-month follow-up.</p> Conclusion <p>The Noddings-based program effectively enhanced death-coping competence, improved death attitudes, and reduced psychological distress in patients with advanced lung cancer.</p> Trial registration <p>ChiCTR2600118530, 2/6/2026 retrospectively registered.</p>