Metaphors in cancer care: Cultural insights from Spanish and Mexican physician-patient interactions.

Objectives: This qualitative study examines the use of metaphors in Spanish-language oncology consultations, highlighting differences between Mexican Spanish and peninsular Spanish and exploring how metaphor use varies between physicians and patients. Methods: Metaphors are common across languages and offer insight into how people conceptualize illness, treatment, and emotional experience. This study analyzed 50 audio-recorded, real-time oncology consultations-25 from Mexico and 25 from Spain-drawn from a corpus of naturally occurring physician-patient interactions. Using the Metaphor Identification Procedure, we systematically coded cancer-related metaphors, such as referring to treatment as a "path" or medication as something that "fights" the disease. Results: Patients use slightly more metaphorical expressions than their physicians. Journey metaphors were the most frequently used across all groups. Battle metaphors were the second most common, though their use varied: doctors primarily used metaphors to explain treatment and motivate patients, while patients often used them to express emotional and physical vulnerability. Differences between varieties of Spanish also revealed culturally specific metaphorical language. Conclusions: Metaphor use is a plain language strategy in oncology. Recognizing how metaphors are used in different Spanish-speaking contexts can enhance culturally and linguistically responsive care. Greater practitioner awareness of metaphorical language can improve patient understanding, reduce confusion, and foster more empathetic, person-centered communication. Practical value: Incorporating culturally appropriate metaphors-tailored to specific language varieties and patient experiences-can support clearer communication, especially in oncology care. This study provides practical examples that can inform training for healthcare providers working with Spanish-speaking populations in the U.S., particularly those of Mexican origin. Innovation: This study is innovative in highlighting cultural differences between two Spanish-speaking cultures, showing that while battle and journey metaphors are the most common, patients primarily use them to express pain, struggle, and vulnerability rather than resilience or strength.