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Grant SJ, Gonzalez M, Heller G, Soliman S, Spiegel G, Lacey J. Knowledge and attitudes towards medicinal cannabis and complementary and integrative medicine (CIM): a survey of healthcare professionals working in a cancer hospital in Australia. Support Care Cancer 2023; 31:623. [PMID: 37819556 PMCID: PMC10567955 DOI: 10.1007/s00520-023-08080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE We investigated attitudes and practices of healthcare professionals (HCPs) to medicinal cannabis (MC) and complementary and integrative medicine (CIM), including individual therapies, such as acupuncture, massage, herbs, dietary supplements, nutrition and exercise. We explored whether healthcare occupation influenced attitudes to CIM and MC; referral pathways for advice on CIM; and interest in a pharmacy service to evaluate herbs and supplements. METHODS Cross-sectional survey. All clinical staff at a comprehensive cancer hospital were invited to complete an anonymous questionnaire about CIM and MC. We used descriptive analysis to describe the respondent's knowledge and attitudes, and Fisher's exact test to test for differences by occupation, length of time at the hospital and age. RESULTS Most of the 116 HCPs respondents supported integrating CIM into cancer care (94.8%) and wanted to learn more (90%) and to understand benefits and contraindications. Most respondents believed that CIM (87.9%) could benefit patients with cancer, and MC could benefit those with advanced cancer (49-51%). Whilst just over half (52.6%) felt confident discussing CIM with patients, only 10% felt they had sufficient knowledge to discuss MC. Most felt they did not have sufficient knowledge to specifically discuss mind and body practices (63.8%) or herbs and supplements (79%). HCPs (63%) would be more inclined to allow use of herbs and supplements with cancer treatment if a pharmacy service was available to evaluate interactions. Occupation, length of time at hospital and age influenced confidence and knowledge about CIM. CONCLUSIONS The integration of evidence-based CIM and MC into cancer care is hampered by a lack of knowledge of benefits and contraindications, and gaps in education. Effective and safe integration may require targeted development of services such as pharmacy to evaluate the safety of herbs and supplements, and inclusion of cancer specialists who have received training in individual CIM therapies and MC.
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Affiliation(s)
- Suzanne J Grant
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia.
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Maria Gonzalez
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Sarah Soliman
- School of Science, Western Sydney University, Sydney, NSW, Australia
| | - Gretel Spiegel
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Judith Lacey
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
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Holman A, Kruger DJ, Lucas P, Ong K, Bergmans RS, Boehnke KF. Healthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian context. J Cannabis Res 2022; 4:32. [PMID: 35698183 PMCID: PMC9195481 DOI: 10.1186/s42238-022-00141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patients use medical cannabis for a wide array of illnesses and symptoms, and many substitute cannabis for pharmaceuticals. This substitution often occurs without physician oversight, raising patient safety concerns. We aimed to characterize substitution and doctor-patient communication patterns in Canada, where there is a mature market and national regulatory system for medical cannabis. Methods We conducted an anonymous, cross-sectional online survey in May 2021 for seven days with adult Canadian federally-authorized medical cannabis patients (N = 2697) registered with two global cannabis companies to evaluate patient perceptions of Primary Care Provider (PCP) knowledge of medical cannabis and communication regarding medical cannabis with PCPs, including PCP authorization of licensure and substitution of cannabis for other medications. Results Most participants (62.7%, n = 1390) obtained medical cannabis authorization from their PCP. Of those who spoke with their PCP about medical cannabis (82.2%, n = 2217), 38.6% (n = 857) reported that their PCP had “very good” or “excellent” knowledge of medical cannabis and, on average, were moderately confident in their PCP’s ability to integrate medical cannabis into treatment. Participants generally reported higher ratings for secondary care providers, with 82.8% (n = 808) of participants rating their secondary care provider’s knowledge about medical cannabis as “very good” or “excellent.” Overall, 47.1% (n = 1269) of participants reported substituting cannabis for pharmaceuticals or other substances (e.g., alcohol, tobacco/nicotine). Of these, 31.3% (n = 397) reported a delay in informing their PCP of up to 6 months or more, and 34.8% (n = 441) reported that their PCP was still not aware of their substitution. Older, female participants had higher odds of disclosing cannabis substitution to their PCPs. Conclusion Most of the surveyed Canadian medical cannabis patients considered their PCPs knowledgeable about cannabis and were confident in their PCPs’ ability to integrate cannabis into treatment plans. However, many surveyed patients substituted cannabis for other medications without consulting their PCPs. These results suggest a lack of integration between mainstream healthcare and medical cannabis that may be improved through physician education and clinical experience. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00141-0.
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Braun IM, Nayak MM, Roberts JE, Chai PR, Tulsky JA, Abrams DI, Pirl W. Backgrounds and Trainings in Cannabis Therapeutics of Dispensary Personnel. JCO Oncol Pract 2022; 18:e1787-e1795. [PMID: 35969815 PMCID: PMC9653199 DOI: 10.1200/op.22.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE A growing body of scientific research indicates that oncology teams tend to offer individuals with cancer little clinical advice regarding medicinal cannabis (MC) and that individuals with cancer instead turn to cannabis dispensaries for MC guidance. Our objective was to investigate dispensary personnel's backgrounds and trainings in MC advising. METHODS The study design was semistructured interviews across 13 states with cannabis dispensary personnel in managerial or client-facing positions. Of 38 recruited, 26 (68%) completed interview. The primary outcome was training in MC advising. Researchers targeted thematic saturation and adhered to Consolidated Criteria for Reporting Qualitative Research. RESULTS Of 26 participants, 54% were female, with an average age of 40 (range: 22-64) years. Half worked in client-facing roles; half worked in managerial ones. Study participants endorsed passionate commitment to their profession, often motivated by personal experience with MC therapeutics. Cannabis dispensaries often privileged sales skills over cannabis therapeutics knowledge when hiring, resulting in uneven baseline levels of cannabis therapeutics expertise among staff. Most participants reported workplace cannabis therapeutics training to be unstandardized and weak. They described dispensary personnel as resourceful in pursuing cannabis knowledge, self-financing learning in off-hours, sampling dispensary products, and exchanging knowledge. Nearly half the participants called for quality, standardized cannabis therapeutics training for dispensary personnel. CONCLUSION The many oncology teams who defer to dispensary personnel regarding MC advising rely on a workforce who views themselves as unevenly trained. Further research should include a national survey of cannabis dispensary personnel to learn whether these findings hold true in a larger sample. If so, the oncology community must determine the best approach to clinically advising individuals with cancer about MC.
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Affiliation(s)
- Ilana M. Braun
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA,Ilana M. Braun, MD, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; e-mail:
| | - Manan M. Nayak
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Phyllis F. Cantor Center for Research in Nursing, Dana-Farber Cancer Institute, Boston, MA
| | - Jane E. Roberts
- Harvard Medical School, Boston, MA,Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA,The Fenway Institute, Boston, MA
| | - James A. Tulsky
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Donald I. Abrams
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - William Pirl
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
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Patell R, Bindal P, Dodge L, Elavalakanar P, Freed JA, Rangachari D, Buss M, Schonberg M, Braun I. Oncology Fellows' Clinical Discussions, Perceived Knowledge, and Formal Training Regarding Medical Cannabis Use: A National Survey Study. JCO Oncol Pract 2022; 18:e1762-e1776. [PMID: 35394802 PMCID: PMC10476741 DOI: 10.1200/op.21.00714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Evidence suggests that patients with cancer frequently use cannabis with medicinal intent and desire clinical guidance from providers. We aimed to determine whether oncology training adequately prepares fellows to discuss medical cannabis. METHODS A national survey study was conducted from January to March 2021. A questionnaire assessing oncology fellows' practices regarding cannabis recommendations in cancer care and their knowledge of its effectiveness and risks compared with conventional care for cancer-related symptoms was developed and sent to 155 US-based oncology training programs to distribute to trainees. RESULTS Forty programs from 25 states participated; of the 462 trainees across these programs, 189 responded (response rate of 40%). Of the participants, 52% were female; 52% were White, 33% Asian, and 5% Hispanic. Fifty-seven percent reported that they discussed medical cannabis with more than five patients in the preceding year; however, only 13% felt sufficiently informed to issue cannabis-related clinical recommendations. Twenty-four percent reported having received formal training regarding medical cannabis. Oncology fellows who reported having received prior training in medical cannabis were significantly more likely to discuss cannabis with patients (risk ratio: 1.37, 95% CI 1.06 to 1.75; P = .002) and feel sufficiently informed to discuss cannabis recommendations (risk ratio: 5.06; 95% CI, 2.33 to 10.99; P < .001). Many viewed the botanical as a useful adjunctive therapy that was at least as effective as conventional treatments for anorexia/cachexia (72%), nausea/vomiting (45%), and pain (41%). CONCLUSION Most oncology trainees not only reported engaging in discussions regarding medical cannabis with patients but also considered themselves insufficiently informed to make cannabis-related clinical recommendations. The discrepancy between the frequency of cannabis inquiries/discussions at the patient level and comfort/knowledge at the trainee provider level represents an unmet curricular need with implications for both graduate medical education and patient care.
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Affiliation(s)
- Rushad Patell
- Hematology and Hematological Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Poorva Bindal
- Hematology and Hematological Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Laura Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pavania Elavalakanar
- Hematology and Hematological Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason A. Freed
- Hematology and Hematological Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Deepa Rangachari
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mary Buss
- Section of Palliative Care, Division of General Medicine and Primary Care, Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mara Schonberg
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ilana Braun
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
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Kalonji P, Revol A, Broers B, Ljuslin M, Pautex S. Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach. Palliat Med Rep 2022; 3:200-205. [PMID: 36203714 PMCID: PMC9531874 DOI: 10.1089/pmr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pauline Kalonji
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Aurélie Revol
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Barbara Broers
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Primary Care Division, University Hospital Geneva, Geneva, Switzerland
| | - Michael Ljuslin
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Sophie Pautex
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
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