Chronic diseases – conditions that are persistent or long-lasting – can have a significant impact on the affected individual, their family, and society as a whole. Collectively, it is estimated that chronic diseases account for around 70% of deaths worldwide. Furthermore, as most chronic conditions currently have no cure, they often require lifelong follow-up, self-management and ongoing treatment. Many patients with chronic conditions may also experience additional conditions and symptoms, such as emotional stress, depression and anxiety.
Some evidence suggests that engaging patients in the self-management of their chronic condition can help to improve their quality of life. Support from healthcare providers in this context has been shown to help patients deal with their symptoms more effectively. However, some factors, such as comorbidities or psychosocial vulnerability, can present significant challenges in patients’ care and self-management, including undermining patient participation in care and treatment adherence.
Medical Cannabis for Chronic Conditions
Chronic pain and co-occurring conditions are among the most common conditions for which medical cannabis products are used. There is a lack of consensus on the overall utility of medical cannabis in treating chronic pain. However, most summaries of evidence agree that there is a need for more high-quality evidence on its effects. The same is true of psychiatric conditions (anxiety, post-traumatic stress disorder, and others), as well as other chronic physical health issues. At present medical cannabis in the UK can only be prescribed to individuals who have failed to receive sufficient benefit from first-line licensed medications as a result.
Many healthcare providers remain reluctant to discuss and support patients’ use of medical cannabis, largely due to concerns about a clear evidence base and a general lack of knowledge about dosing, side effects and other considerations. The authors of a recent review suggest that studying the perceptions of patients with chronic diseases of medical cannabis and their motivation to use it could help to “identify its major issues to eventually produce coherent treatment plans.”
They also acknowledge that involving patients could help better assess challenges and facilitators in their self-management and identify crucial elements that may otherwise have been overlooked. With this in mind, the researchers aimed to “map out and analyse the literature on the perception and engagement of patients living with oncological and non-oncological chronic conditions regarding the use of medical cannabis.”
Design and Methods of the Study
The researchers adopted a scoping review design for the present study. They identified six major concepts related to: patients, oncological and non-oncological chronic disease, perceptions, cannabis, medical use, and effects. Following the application of eligibility criteria, 53 articles, published between 2003 and 2022, were included in the final review.
The included articles assessed the perceptions of patients living with oncological and non-oncological chronic conditions of therapeutic cannabis, both prescribed and self-purchased, and were conducted in 14 different countries.
The most common chronic diseases represented in the studies were: cancer (n = 17), chronic pain (n = 6), inflammatory bowel disease (n = 4), multiple sclerosis (n = 3), chronic conditions at large (n = 3), human immunodeficiency virus (HIV) (n = 2), schizophrenia (n = 2), spinal cord injury (pain) (n = 2).
Results of the Study
Perceptions of Medical Cannabis
Regarding the patients’ perception of medical cannabis, four main themes were identified: (1) reasons to use, to stop using or not to use medical cannabis; (2) beliefs about and knowledge of medical cannabis; (3) effects of medical cannabis on patients themselves and empowerment; and (4) discussion of medical cannabis with relatives and healthcare professionals.
-
Reasons to use, to stop using or not to use medical cannabis
Forty-three articles studied patients’ motivations to use, stop using, or not use medical cannabis. Reasons given by patients for using medical cannabis included: changes in symptoms (47%), reasons in relation to other medications being taken (24%), changes in quality of life (23%), reasons in relation to the disease (21%), and information found or discussion (23%).
Reasons to stop using medical cannabis included: ineffectiveness or loss of interest in using medical cannabis (17%), side effects (15%), concerns about medical cannabis (11%), access difficulties (11%), and advice from healthcare providers or relatives (8%).
Reasons not to use medical cannabis included: access difficulties (36%), concerns about medical cannabis (28%), research missing or lack of information on medical cannabis (26%), advice from healthcare providers or relatives (13%), and personal choice (13%).
-
Perceived effects of medical cannabis on patients themselves and empowerment
Forty-five articles focused on a biological level and described the perceived results of medical cannabis therapy Most asked patients questions about the effects of medical cannabis on their symptoms (75%), and some inquired about new perceived side effects on self and symptoms (47%) and effects on quality of life (38%).
Fifteen articles studied perceived effects in terms of the empowerment medical cannabis had on patients, such as decision-making in their own care or treatment path (21%), and the will to participate in research activities (6%). Some studies have also noted the positive feelings of empowered patients, such as a comforted feeling for being in control (8%).
-
Beliefs about and knowledge of medical cannabis
Forty-one articles addressed the patients’ beliefs about medical cannabis, including concerns and risk perceptions (n = 28); almost half (n = 22) evaluated the social support of comfort level using medical cannabis.
Other elements analysed included: comparisons with other medications (n = 12), stereotypes (n = 6), the impact of the media and pharmaceutical companies (n = 3), the expected effects on those who plan to use MC (n = 2), and the conditions of use of MC (n = 3). In addition, 29 articles evaluated the patients’ knowledge of MC. Questions related to: information research on MC (38%), general knowledge of MC (23%), and on MC effects (9%).
-
Discussion about medical cannabis with relatives and healthcare professionals
Twenty-two articles inquired about discussions with the patients’ relatives and 27 evaluated patients’ discussions with healthcare professionals. Elements of discussion included: concerns about or experienced stigma (19%), level of comfort using medical cannabis (17%), advice received from relatives (15%), level of support received from relatives (13%) and cannabis use by relatives (11%), as well as perceived attitude of healthcare providers (30%) and whether patients have requested information about medical cannabis or disclosed their medical cannabis use (28%).
Conclusions
These findings demonstrate that the most common reasons for using medical cannabis were for symptoms (47%) and quality of life (23%), which is consistent with previous studies. Furthermore, the main reasons to stop using medical cannabis were ineffectiveness, followed by side effects.
Only 20% of the included articles looked at the empowerment, decision-making or self-image of medical cannabis patients. The authors note that developing an interest in patients’ own management of medical cannabis could help healthcare providers understand patients’ adherence to and observance of treatment strategies.
The authors also recommend that future studies aim to explore how access affects the decision for people living with chronic conditions to use or not to use medical cannabis, and to further explore the relationship between healthcare providers and patients as a barrier to medical cannabis access.
