Purpose <p>Cancer incidence is rising in Hong Kong, with over half of common cancers diagnosed at advanced stages, placing substantial demands on families and driving high caregiver distress. Meaning-centered psychotherapy for cancer caregivers (MCP-C) shows promise in Western settings but requires cultural tailoring for Chinese caregivers whose values are shaped by Confucian ethics. This study aimed to culturally and linguistically adapt MCP-C for Chinese caregivers of patients with advanced cancer in Hong Kong to enhance acceptability, relevance and conceptual equivalence.</p> Methods <p>Guided by the ORBIT model and Bernal’s ecological validity model (EVM), we conducted semistructured interviews with nine cancer caregivers and eight healthcare professionals (oncologists, nurses, social worker and clinical psychologist). The manual was translated and transcreated into traditional Chinese. Analysis used a hybrid deductive–inductive approach anchored to EVM domains with dual independent coding and consensus adjudication.</p> Results <p>Adaptations spanned all eight EVM domains (language, persons, metaphors/stories, content, goals, methods, concepts and context), including reframing “meaning” around family roles and filial responsibility, integrating Cantonese idioms, simplifying terminology, rebranding as a “meaning-centered well-being program,” and enabling online delivery to improve feasibility.</p> Conclusion <p>This systematic adaptation preserved therapeutic fidelity while enhancing cultural fit for Chinese caregivers. A mixed-methods feasibility study will evaluate acceptability, appropriateness and preliminary outcomes (meaning in life, distress, spiritual well-being and benefit finding) to inform subsequent efficacy trials.</p>