Table 2.

The Results of the Qualitative Content Analysis.

Categories	Subcategories	Quotations
Education barriers	Insufficient awareness of the public	“Public awareness about palliative care and home care is not enough, Radio and TV, as informative media, should be very active specially in Corona time and support such healthcare services. . . .the State of Welfare Organization should be involved in providing necessary information about healthcare services and preferences for cancer patients at home.” (Participant 1, Health Policymaker)
	Culture building	“In the public sight, there is no difference between care and treatment, and the hospital is the right place for both; a change in this mindset requires culture-building. Most people want their patient to be in the hospital until the last minute, and they are not willing to transfer him/her to home. Corona crisis and vulnerability of patients for being in the hospital, has made the needs of the society greater” (Participant 21, Head of the Home HealthCare Center)
	Insufficient trained healthcare providers	“The novelty of applying the concepts of palliative care and spiritual care at home in our society and the shortage of a strong educational curriculum in the university, are important reasons for insufficient trained healthcare providers.” (Participant 14, Nurse)
Implementation barriers	Access to a specific schedule of hospital discharge for cancer patients	“Some patients need to be referred to home care centers after hospital discharge, while some patients don’t need. Therefore, cancer patients should have a specific discharge schedule for hospital discharge and returning home, including follow-up and telephone counseling during 24 hours of the day, a list of common patients’ problems, warning signs, medications, and emphasis on self-care training and visiting time (Participant 5, Researcher in the Home Care)
	Establishment of a strong infrastructure	“At first we need policy making in this area, actually we need a specific infrastructure for home-based palliative care in our society which should be flexible in the time of crisis like COVID-19 pandemic. . . . There are several barriers to set up home care centers with specialized palliative care services. . ..not enough facilities, insufficient budget allocation, insufficient training and shortages of trained staff, we need connected palliative care clinics to home healthcare centers and hospice, challenges for access to medicines and insurance coverage at home, also access to a specific electronic platform, are important current challenges for home-based palliative care in our healthcare system.” (Participant 1, Health Policymaker)
	Involving graduated community health nurses	“We need specialized personnel in the field of home-based palliative care. Community health nurses with specialized training in the field of home healthcare, can be active in this specific field at home. Unfortunately they are not involved in the care at home and community in our society. (Participant 7, Factually Member)
	Access to packages of home-based palliative cancer care services	“In order to increase quality of life of cancer patients, they need to receive comprehensive and standard healthcare services after hospital discharge. A specific care track for cancer patients and their family prevents their confusing after hospital discharge; this will be possible by access to comprehensive packages of healthcare services with specific guidelines for cancer patients and palliative care at home and end of life care. . . . . . now we need special packages for palliative care in cancer patients during the disease of Corona also.” (Participant 13, Home HealthCare Nurse)
	Cohesion and professional solidarity in the home-based palliative care team	“in my opinion when we talk about palliative healthcare team, cooperation and coordination between the team members are essential. We need to have a national symposium or meeting with our home care colleagues.” (Participant 17, Home HealthCare Nurse)
	Necessity of cancer patient’s follow-up after hospital discharge	“After the mastectomy, I was discharged from the hospital with a note containing only a few lines about the complications after surgery, the medications and the time of the next visit to the doctor . . . . After that, no one called me to follow up my condition while I need to it.” (Participant 22, Patient)
	Poor transitional care from hospital to home	“Poor transfer of care from the hospital to home care centers, the lack of patient follow-up after hospital discharge and 24-hour telephone consultation, and the lack of an electronic platform for recording of patient’s data and transferring information to home care centers can be an obstacle to safe transfer from hospital to home. ” (Participant 1, Health Policymaker)
	Access to a coordinate nurse	“The existence of a coordinator to coordinate healthcare services and plan for integrated healthcare services is an important issue for reducing patient readmission at hospital.” (Participant 9, Home HealthCare Nurse)
	Insufficient involvement of patients and their family in caring	“One of the principles of transitional care from hospital to home, is the involvement and participation of patients and their families in the process of caring and recieving education and supportive care.” (Participant 7, Faculty Member)
Policy barriers	Weaknesses in legal-security issues for home care	“Providing security in home visits, is another essential challenge during delivering palliative home care. Since, the visit takes place at home in an informal place for caring, it can pose risks to the family and healthcare providers, so it makes sense if healthcare providers would be very cautious or are not willing to enter that area . . . ”(Participant 6, Home HealthCare Nurse)
	The loss of health insurance coverage for home healthcare services	“A patient with cancer should not be in charge of self-protection. When a patient come back home from hospital and go under caring of home healthcare centers, he/she cannot be under coverage of the health insurance. There is no health insurance for coverage of home healthcare services in our healthcare system.” (Participant 2, Health Policymaker)
	The lack of liability insurance for home healthcare providers	“Working alone and without liability insurance in home care centers, produce a lot of stress for the home care nurses and makes working conditions difficult for them.” (Participant 17, Home HealthCare Nurse)
	Non-transparent payment medical tariffs for home health care services	“The lack of a transparent tariffs for healthcare services provided at home, should be taken into account. In some cases, the lack of tariffs for these services has led to families’ paying higher costs and taking action subjectively.” (Participant 14, Nurse)
	The need for a flexible home-based palliative care model	“The existence of a flexible home palliative care model, assist to plan for transition of healthcare of the patient from hospital to home in accordance with the healthcare system, especially in the current situation when we have the Corona disease and there should be specific precautions at hospital, home and community for disease prevention.” (Participant 8, Expert of Home Care in the Ministry of Health)
Drug availability barriers	Limitations for oral and non-oral narcotic medications at home	“The biggest challenge regarding medication is the lack of oral morphine in our country. Another challenge is related to the prescription of the narcotics at home, for example in our home care center, specialist physician can prescribe narcotic medicines and a general practitioner cannot. . . . in some cases, our patients even have problems with providing injectable morphine also. . . it is not easy to find morphine, especially with spreading of Corona and limited access to the medicines and shortages. . . . our patients problem is more than earlier. It is advised to have clear regulations and rules for prescription of narcotics. Also, there must be better access to narcotics for cancer patients at home. ” (Participant 3, Physician)
	No legal permission for nurse prescribing	“In our healthcare system, nurse prescribing is not legal. If a patient get diarrhea, a home healthcare nurse knows that the patient needs Dicyclomine or Loperamide in this condition. . . but our nurses have no license or permission for prescription of medicines, therefore they cannot prescribe at home and manage symptoms of cancer patients. ”(Participant 5, Researcher in the Home Care)