Elucidating an explanatory model for cancer care management within the urban family physician setting in Iran: a qualitative grounded theory study

Cancer care management requires coordinated and continuous services across prevention, diagnosis, treatment, and supportive care pathways. Despite ongoing efforts to strengthen primary healthcare in Iran, an integrated framework explaining how cancer care can be organized within the urban family physician setting remains insufficiently developed. This study aimed to develop an explanatory model for cancer care management within the urban family physician system based on the experiences and perspectives of key healthcare stakeholders. This qualitative study was conducted using a grounded theory approach between 2025 and 2026. Thirty-six stakeholders, including family physicians, clinical specialists, healthcare managers, policymakers, and faculty members, were recruited through purposive sampling followed by theoretical sampling. Data were collected through individual semi-structured interviews and analyzed using constant comparison and the three stages of grounded theory coding (open, axial, and selective coding) with MAXQDA 2020 software. Theoretical saturation was assessed based on the development and refinement of categories and their conceptual relationships. The rigor of the study was ensured using established qualitative trustworthiness criteria. Analysis resulted in the development of an explanatory model comprising 7 main categories, 18 subcategories, and 122 initial codes. The core category was identified as “Developing integrated and coordinated cancer care within the urban family physician system.” The findings indicated that fragmented governance and unclear stewardship acted as upstream conditions influencing organizational capacity, referral coordination, information integration, and continuity of care. These interconnected mechanisms subsequently shaped challenges across cancer prevention, early detection, treatment coordination, supportive care, and patient engagement. The developed explanatory model highlights that effective cancer care management within the urban family physician system depends on strengthening coordination across healthcare levels rather than addressing isolated service deficiencies. The findings provide evidence-informed insights for improving governance structures, referral pathways, information integration, and continuity of cancer care in primary healthcare settings.