Culture encompasses shared values, beliefs, behaviors, and social structures that shape health perceptions, care-seeking behaviors, and interactions within healthcare systems (1). As a dynamic and socially constructed phenomenon, culture influences how illness is interpreted, how ethical uncertainties and moral distress arise, and how patients, families, and healthcare providers engage in decision-making processes (2, 3). In oncology care, these influences are particularly pronounced, as cancer trajectories often involve emotionally charged decisions, family negotiation, and end-of-life considerations.

To strengthen conceptual clarity, this study is informed by established cultural competence frameworks, including the Campinha-Bacote model, which emphasizes cultural awareness, knowledge, skill, encounters, and desire (4), and the Papadopoulos model, which conceptualizes cultural competence as a developmental process from awareness to culturally competent practice (5). Together, these frameworks provide an interpretive lens for understanding how culturally shaped interactions unfold within cancer care and guided the formulation of the research questions and analytic interpretation.

Healthcare systems increasingly serve culturally diverse populations, particularly in regions affected by migration and displacement. Migrant and refugee populations often present distinct health profiles and cultural expectations, posing challenges related to communication, decision-making, and institutional norms (6, 7). Culturally sensitive care defined as care that respects individuals’ values, beliefs, and social contexts has therefore become central to discussions of health equity, human rights, and social justice (8). Cultural factors also shape illness interpretation, perceptions of quality of life, expressions of pain, family roles, and engagement with health-related rituals, all of which complicate cancer care delivery (9, 10).

Jordan has experienced substantial population movement due to regional conflicts, intensifying cultural diversity within its healthcare system. While prior studies in Jordan and the broader Middle East have documented the influence of cultural beliefs on treatment decisions, pain management, and adherence to medical recommendations (11, 12), this evidence has largely been generated through quantitative designs or from healthcare provider perspectives. Consequently, limited attention has been paid to how patients and families themselves experience and navigate culturally embedded cancer care. Persistent cancer-related stigma, religious interpretations of illness, and misconceptions about treatment such as beliefs that surgery may spread cancer continue to influence care-seeking behaviors and trust in medical services (13).

Cultural experiences of cancer care are inherently relational, value-laden, and embedded within social and family contexts. These experiences shape how diagnoses are communicated, how decisions are negotiated, and how care is ultimately received, yet they cannot be adequately captured through quantitative measures alone. A qualitative approach is therefore essential to explore the meanings patients and families assign to cancer care encounters, particularly in contexts where cultural norms strongly influence communication, shared decision-making, and expectations of care (14–16).

Despite growing recognition of the importance of culturally responsive oncology practice in the Middle East, qualitative evidence examining culturally grounded cancer care experiences remains limited in Jordan. Existing research has focused predominantly on clinical outcomes or provider-reported perspectives, leaving a critical gap in understanding cancer care trajectories from the viewpoints of patients and caregivers. Building on calls for patient-centered cancer care (17) and drawing on experiences at the King Hussein Cancer Center, this study employs qualitative inquiry to explore how cultural beliefs and practices shape cancer care in Jordan. By foregrounding patient, caregiver, and healthcare provider perspectives, the study aims to generate context-sensitive insights that can inform culturally responsive care models, enhance communication and shared decision-making, and ultimately improve the quality and equity of oncology care.

This multi-center qualitative study advances understanding of culturally embedded cancer care by demonstrating how beliefs and everyday practices in Jordan function as mechanisms that actively shape communication, decision-making, and care experiences, rather than serving as passive background characteristics. While prior studies have documented similar cultural dimensions in oncology and palliative care (22, 23), our findings are analytically distinctive in illustrating how these dimensions operate within a Jordanian sociocultural context characterized by strong family interdependence, faith-based meaning-making, and moral obligations surrounding protection and responsibility. One of the most salient contributions of this study is the role of traditions and rituals in preserving identity, comfort, and continuity during the cancer trajectory. Preferences for homemade food reflect what anthropological literature describes as symbolic nourishment, where food serves not only nutritional needs but also emotional and spiritual functions (24). In our data, hospital meals were often perceived as impersonal or culturally incongruent, disrupting patients’ sense of normalcy and prompting reliance on family-provided food. This finding aligns with Larsen et al.’s (2021) work highlighting how institutional food environments influence patients’ motivation to eat, yet extends it by showing how cultural meaning attached to food mediates engagement with hospital care in Jordan (25). Visitation practices and religious rituals similarly acted as stabilizing forces, offering emotional reassurance and reinforcing social bonds patterns consistent with evidence that spiritual and relational practices enhance quality of life in advanced cancer across settings, but here deeply embedded in collective cultural norms (26).

Participants’ conceptualizations of cancer further demonstrate how cultural beliefs shape care experiences through pluralistic explanatory models. While biomedical and environmental explanations such as genetics, pollution, war exposure, and diet were common, many participants simultaneously interpreted cancer as a divine test or spiritually meaningful experience. These interpretations influenced coping strategies, treatment acceptance, and communication with healthcare providers. Unlike findings from Australian and Vietnamese contexts, where cancer risk is often attributed primarily to aging or nutrition, participants in this study integrated spiritual, emotional, and sociopolitical explanations, underscoring how illness meaning is constructed within broader moral and historical contexts (27).

Decision-making and information-sharing practices revealed another analytically distinctive feature: the predominance of relational autonomy. Consistent with Yennurajalingam et al.’s (2018) international findings showing variability in decisional control preferences, our data illustrate that many Jordanian patients favored shared or family-mediated decision-making (28). Authority was often distributed among physicians, patients, and key family members, particularly spouses or senior male relatives reflecting cultural norms of collective responsibility. In this context, autonomy is not conceptualized as individual independence but as relational, negotiated, and embedded within family structures, aligning with broader ethical discussions on relational autonomy in clinical care (29).

Information withholding, particularly from children or older adult(s) patients, further highlights how protective intentions rooted in care and moral responsibility shape communication practices. Similar patterns have been observed in pediatric oncology settings in Jordan, suggesting a culturally consistent approach to disclosure aimed at minimizing psychological harm (7). While such practices may conflict with Western norms of full transparency, our findings emphasize the importance of culturally sensitive negotiation rather than prescriptive application of disclosure standards.

Psychosocial and practical concerns illuminated how cancer disrupts entire family systems, not only individual patients. Fears of disease progression, physical decline, and becoming a burden echoed findings from palliative care studies in other contexts (30, 31), yet in Jordan these concerns were deeply intertwined with cultural expectations regarding breadwinning, caregiving, and intergenerational responsibility. Patients’ anxieties about their children’s futures and caregivers’ fears of losing moral and emotional anchors underscore the relational nature of suffering and highlight the need for family-centered supportive interventions.

Preferences regarding healthcare providers’ characteristics further reinforce the importance of cultural congruence in care delivery. While clinical competence was universally prioritized, preferences for same-gender nurses during intimate care and for Arabic-speaking providers reflected values of modesty, privacy, and trust. These findings parallel evidence from Saudi Arabia emphasizing the role of cultural alignment in nursing care, while underscoring practical implications for staffing, training, and communication strategies in culturally diverse oncology settings (32).

Importantly, the inclusion of non-Jordanian participants many from migrant or displaced backgrounds situates these findings within broader regional and global dynamics of migration and conflict (10). The mechanisms identified here are therefore relevant not only to Jordan but also to other healthcare systems serving Arab, Muslim, and collectivist populations. By clarifying how beliefs and practices shape care experiences, this study provides empirically grounded insights to inform culturally responsive communication, shared (relational) decision-making, and service adaptation for diverse and migrant populations.

Collectively, these findings extend existing literature by moving beyond descriptive accounts of cultural beliefs to demonstrate how culture actively structures cancer care experiences. Integrating such insights into clinical training and institutional policies is essential for advancing cultural competence as a core component of equitable, patient-centered oncology care.

This study directly addresses how cultural beliefs and practices shape the cancer care journey in Jordan, influencing communication preferences, decision-making patterns, coping strategies, and perceptions of family responsibility. By clarifying these culturally grounded mechanisms, the study identifies opportunities for improving culturally responsive and patient-centered oncology care.

From food to faith, from communication preferences to caregiving dynamics, the findings reveal that healthcare is not merely a set of procedures, but a relational, spiritual, and emotional landscape traversed by patients and families alike.

Understanding how cultural values shape preferences for information sharing, spiritual coping, and interpersonal boundaries can enhance patient-centered care. Healthcare providers must move beyond biomedical checklists and engage with the patient’s worldview, recognizing that illness is as much a social and moral disruption as it is a physical one.

Just as a sailor reads not only the map but also the wind, healthcare teams must attune themselves not only to clinical data but also to cultural and emotional cues. This requires training in communication, empathy, and cultural humility, especially in regions with strong familial ties and spiritual belief systems.

Future research should explore how these themes vary across age, gender, and socio-economic strata and how healthcare systems can design culturally congruent models of care that are both ethically sound and practically feasible. Ultimately, the integration of cultural competence into cancer care is not an optional luxury but a fundamental pillar of equitable, compassionate, and effective medicine.