Online first
Research paper
Published online: 2024-07-24

open access

Page views 30
Article views/downloads 14
Get Citation

Connect on Social Media

Connect on Social Media

Attitudes and experiences about medical cannabis in palliative care patients and caregivers in Thailand: a qualitative study

Khanet Khamjae1, Win Techakehakij1, Wararat Thatayu1, Napat Phetkub1, Nutchar Subhamani1

Abstract

Background: Although cannabis has been introduced to alleviate symptoms in palliative care patients for decades, research on the attitudes and experiences of patients and their caregivers regarding its use remains limited. This qualitative study explores their perspectives on this newly legalized treatment option.

Methods: A purposive sample of 20 participants (12 patients, 8 caregivers) visiting cannabis or palliative clinics (May–November 2023) were interviewed face-to-face using semi-structured questions. Interviews were recorded, transcribed, and analyzed thematically until saturation was reached. Triangulation techniques ensured data credibility.

Results: Six major themes were identified: 1) attitudes toward medical cannabis, with some viewing it as medicine and others as an illegal drug; 2) reasons for medical cannabis use, mostly used for symptom relief, with some hoping to cure diseases; 3) sources of information, from cannabis users, healthcare providers, and the internet; 4) issues of support, family and physicians being a major role influencing patients’ decisions to use cannabis; 5) barriers, access being impeded by the perspectives of some physicians and social judgment; and 6) medical outcome perception, effects of medical cannabis varied considerably between individuals.

Conclusions: While some patients and their caregivers consider medical cannabis as an alternative drug, concerns about social judgment, attitudes about illegal drugs, safety concerns, and a reluctance among healthcare providers to discuss or recommend cannabis, remain barriers to access. Information from this study could in part be used for healthcare professionals to consider the use of cannabis in these patients.

Article available in PDF format

View PDF Download PDF file

References

  1. Abramovici H, Lamour S-A, Mammen G. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html#a1.1. (20.10.2022).
  2. Johnson JR, Burnell-Nugent M, Lossignol D, et al. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage. 2010; 39(2): 167–179.
  3. Freeman TP, Hindocha C, Green SF, et al. Medicinal use of cannabis based products and cannabinoids. BMJ. 2019; 365: l1141.
  4. Mücke M, Weier M, Carter C, et al. Systematic review and meta-analysis of cannabinoids in palliative medicine. J Cachexia Sarcopenia Muscle. 2018; 9(2): 220–234.
  5. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015; 313(24): 2456–2473.
  6. Allan GM, Ramji J, Perry D, et al. Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Physician. 2018; 64(2): 111–120.
  7. Mechoulam R, Hanus L. A historical overview of chemical research on cannabinoids. Chem Phys Lipids. 2000; 108(1–2): 1–13.
  8. Aggarwal SK. Use of cannabinoids in cancer care: palliative care. Curr Oncol. 2016; 23(2): S33–S36.
  9. Doppen M, Kung S, Maijers I, et al. Cannabis in palliative care: a systematic review of current evidence. J Pain Symptom Manage. 2022; 64(5): e260–e284.
  10. Controlled Narcotic Drugs According to Narcotic Drugs Act, 136 (2019).
  11. Cyr C, Arboleda MF, Aggarwal SK, et al. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med. 2018; 7(4): 463–477.
  12. Srisubat A, Thanasithichai S, Thaiyakul A, et al. Outcomes of THC enriched in advanced staged cancer patients. J Depart Med Serv. 2021; 45(4): 208–214.
  13. Ng S, Lingard L, Kennedy TJ. Qualitative research in medical education. In: Swanwick T. ed. Understanding medical education: evidence, theory and practice. Wiley, London 2013: 371–384.
  14. Carter N, Bryant-Lukosius D, DiCenso A, et al. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014; 41(5): 545–547.
  15. Peersman G. An introduction to triangulation. (Monitoring and Evaluation Fundamentals Series, 2010). https://www.unaids.org/sites/default/files/sub_landing/files/10_4-Intro-to-triangulation-MEF.pdf (2.04.2024).
  16. Nowell L, Norris J, White D, et al. Thematic analysis. Intern J Qualit Meth. 2017; 16(1).
  17. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022; 292: 114523.
  18. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2016; 18(1): 59–82.
  19. Zimmerman A, Laitman A. Safe management of adverse effects associated with prescription opioids in the palliative care population: a narrative review. J Clin Med. 2024; 13(10).
  20. Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep. 2022; 71(3): 1–95.
  21. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008; 11(2 Suppl): S105–S120.
  22. Bemand‐Qureshi L, Gishen F, Tookman A. Opioid use in palliative care: new developments and guidelines. Prescriber. 2019; 30(4): 25–31.
  23. Buchwald D, Winter KAI, Brønnum D, et al. Perception of patients with cancer enquiring about adjuvant therapy with cannabis medicine for palliation of symptoms: an interview study among danish health care professionals. Palliat Med Rep. 2022; 3(1): 75–79.
  24. Tanco K, Dumlao D, Kreis R, et al. Attitudes and beliefs about medical usefulness and legalization of marijuana among cancer patients in a legalized and a nonlegalized state. J Palliat Med. 2019; 22(10): 1213–1220.
  25. Luckett T, Phillips J, Lintzeris N, et al. Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: a survey of preferences, attitudes and beliefs among patients willing to consider participation. Intern Med J. 2016; 46(11): 1269–1275.