Table 3 Categories and subcategories emerged in the qualitative phase of the study

Structure of the health system as an opportunity

Using the PHC principles in the healthcare system

Access to the comprehensive health centers for all; healthcare providers have access to the records of patients with cancer. In the comprehensive health centers, healthcare is provided based on the PHC principles, variety in health staff in the comprehensive health centers, families have close relationship with the comprehensive health centers.

“… one of the programs that is very important and can be employed in the PHC framework is care of patients with cancer … [18]”.

Exchange of information electronically

Existence of an integrated electronic health system to record people’s information into the health system; the electronic exchange of information in all sections of the Ministry of Health; access to the information of all families through an integrated electronic health system

“… the ideal state is one in which the integrated electronic health system is linked to patients’ information in hospitals. Consequently, referral and patient care programs are performed easily … [18].

Establishment of the referral system

There is a referral system in rural areas and small towns. The referral system is a priority for the Ministry of Health. The referral system is carried out as a pilot in several provinces. The referral system can be used for cancer patients as a reverse referral.

“… In the care of patients with tuberculosis and leprosy … are identified in higher level … from a subspecialist and specialist is referred reversely … [18]”.

Establishment of family physician

Establishment of a family physician in rural areas and small towns, coverage of a specific population by family physician, cancer patients are also under the covered population. The plan of family physician includes performing in several provinces as a pilot.

“… family physicians cover the population. Any individual who needs palliative care is under the coverage of one of these physicians so … family physician should be included in the palliative care … [18].”

Requisites

Home care team in palliative care at the PHC level

Necessity of defining a specific population for a home care team, necessity of defining a home care team in the PHC structure; necessity of communication between a healthcare team and comprehensive health centers, delivery facilities that exist in the PHC can be used as a model. A home care team can support cancer patients effectively.

“… in this case, I remember delivery facilities and minor surgery centers, … accessible for 20,000 population … in 5–6 health centers … in a health center, we establish delivery facilities … [18]”.

Narcotic management

Necessity of pain management in patients with cancer; necessity of appropriate structure to regulate access to narcotics; necessity of a structure to monitor usage of narcotics in patients

“… we can provide three groups of narcotics including morphine, methadone, and Pethidine to patients based on the monthly prescription … [21]”.

Equipment management

Terminally ill cancer patients need various equipment. Necessity of defining appropriate structure for equipment management; necessity of easy access to the equipment for patients; patients can borrow equipment.

“… portable suction … before transferring the patient to home, bed and equipment should be provided … patients can borrow these [17].”

Social coverage

Necessity of home-based palliative care covered by insurance; defining tariff of home-based palliative services; one of the barriers of access is financial issues.

“… all services should be free or with little franchise … for example, patients with diabetes or hypertension. Indeed, less is paid by patient … [19]”.

Legal issues

Necessity of considering legal issues; necessity of defining moral guidelines for care of terminally ill patients; necessity of developing a deal between families and healthcare centers

“… the first thing to commit both the center and patient is an agreement … [19]”.

Outcomes

Facilitating access

Easy access to healthcare; facilitating access based on what international organizations emphasize.

“… when a service is placed in the PHC structure, it is expected to be free. Indeed, financial access is provided …” [18].

Good death

Providing proper conditions for peaceful death; using psychological consultation for facilitating death; dying at home for patient and family is easier.

“… with comfort provided to the family using a psychologist, using various people can improve quality of death …” [18].