Transcultural Nursing in Oncology During Ramadan: A Case Report Using Leininger’s Sunrise Enabler to Support Oral Premedication Adherence

Abstract

Introduction. During Ramadan, Muslim patients fast from dawn to sunset. For people with complex conditions or continuous treatment, fasting may create specific clinical needs. In oncology, patients may continue fasting without informing the healthcare team, while oral medication may be perceived as invalidating the fast. Reconciling therapeutic adherence, spiritual identity, and clinical safety may therefore be challenging. This case report aimed to describe transcultural nursing care provided to a Muslim patient attending an oncology day hospital during Ramadan, using Leininger’s Sunrise Enabler.

Methods. This case report concerns a 52-year-old Bangladeshi Muslim man with lung adenocarcinoma receiving amivantamab. During a scheduled oncology day hospital visit in Ramadan, he declined the prescribed oral premedication because he feared it would invalidate his fast. Assessment identified religious and spiritual beliefs as priority care factors. Interventions comprised cultural care preservation and maintenance, respecting the spiritual value of sawm; accommodation and negotiation, through education about rukhsa and the involvement of an imam; and repatterning and restructuring, through discussion of fidya as a possible religious accommodation. The patient subsequently accepted the oral premedication, allowing treatment to proceed without delay.

Results. Following the transcultural consultation, the patient demonstrated an understanding of the religious options discussed with the imam and accepted the oral premedication. Amivantamab treatment was administered as scheduled, without postponement or interruption. At subsequent visits, the patient showed greater willingness to discuss religiously related care needs proactively with the healthcare team.

Discussion. Use of the Sunrise Enabler supported dialogue between religious practice and therapeutic safety. The integration of transcultural assessment, intercultural mediation, and religious support facilitated informed adherence while respecting the patient’s values. This case supports strengthening transcultural competencies among oncology nurses and developing locally adaptable pathways for discussing fasting and medication during Ramadan.