The adaptation expands the club from five to eight members with added diverse original characters including Aya Furukawa as Natsuki and Sauriyan Sapkota as Amesh. Spencer, who has AIDS and is gay with a religious mother who disowns him, receives a prominent arc involving homophobia, acceptance, and a story told by Sandra that affirms queer love; additional queer elements include new character Mark (gay nurse) and Cheri's coming-out moment.

These changes and identity-focused subplots sit alongside the core premise of terminally ill teens telling horror stories and uncovering a cult mystery at the hospice, making progressive casting and representation noticeable drivers of character arcs without being the foundational premise. Audience reactions explicitly called out the "race swapped" cast and "forced" gay content as unrealistic in a small group setting.