Ethical challenges in end-of-life cancer care: a qualitative study among health-care providers in Iran

Abstract Background Cancer is one of the most critical and ethically challenging health issues worldwide. Providing end-of-life care to cancer patients often places health-care providers in morally complex situations, where professional duties, cultural expectations, and legal–religious mandates intersect. Despite growing global interest in end-of-life ethics, there is limited understanding of how these challenges are experienced in culturally specific contexts such as Iran. This study aimed to explore the ethical challenges faced by health-care providers caring for cancer patients during the end-of-life stage. Methods This study employed a qualitative conventional content analysis approach. Data were collected between July 2024 and June 2025 in oncology and palliative care centers affiliated with Mashhad University of Medical Sciences. Fourteen participants—including physicians, nurses, psychologists, and psychiatrists—were selected through purposeful sampling with maximum variation. Data were gathered via semi-structured, in-depth interviews, audio-recorded, transcribed verbatim, and analyzed inductively following the framework of Elo and Kyngäs (2008). Rigor and trustworthiness were ensured using Lincoln and Guba’s criteria of credibility, dependability, confirmability, and transferability. Results Analysis yielded 237 initial codes, grouped into 14 categories, 6 sub-themes, and 3 themes: Deliberately Avoiding Telling the Truth, Decision-Making Immersed in Distress and Doubt, and Absence of Purposeful Coherence in the End-of-Life Care Trajectory. These findings illustrate how ethical practice in end-of-life care is shaped by the interplay of individual emotions, institutional limitations, and sociocultural norms. Conclusion End-of-life care for cancer patients in Iran is morally demanding and requires ethical, emotional, and institutional support for health-care providers. Reform efforts should include developing national ethical guidelines, establishing hospital ethics committees, enhancing communication and ethics training, and promoting cultural openness toward death and dying. These measures can foster compassionate, patient-centered, and ethically coherent care at the end of life.