Authors: Colene Bentley, Sara Izadi-Najafabadi, Adam Raymakers & Helen McTaggart-Cowan
Abstract
Introduction
The legalization of recreational cannabis use can enable cancer survivors to manage aspects of their care with cannabinoids without medical authorization or stigmatization. However, the absence of medical guidance—from the scientific literature or the healthcare system—makes it difficult for survivors to reach informed decisions about their care.
Objective
This article outlines the qualitative research undertaken to design a discrete choice experiment (DCE) aimed at understanding Canadian cancer survivors’ preferences for managing their cancer symptoms with cannabis in this complex socio-medical context.
Methods
In this study, we drew on previously published qualitative research (a literature review and interviews with cancer survivors) and the theory of planned behavior, holding weekly team meetings to review the qualitative data and identify initial attributes associated with medicinal cannabis consumption to inform the DCE design. The initial attributes were further assessed to determine whether they were sensitive to the Canadian context, modifiable to produce levels and trade-offs, and amenable to policy intervention, in order to form the DCE choice sets. The choice sets were tested via think-aloud exercises with members of the general population and included debriefing interviews. Think-aloud participants were recruited from patient groups and previous studies.
Results
Based on our review of the interview study, we identified the following attributes associated with selecting medicinal cannabis: effectiveness; chance of side effects; support from family, friends, and/or physicians; cost; and availability. Ability to perform everyday activities was added and monthly out-of-pocket cost was refined to render the DCE realistic to cancer survivors in the Canadian context. Revisions to the DCE instructions, terminology, and cost levels were made based on results from the think-aloud exercises (n = 10).
Conclusions
This qualitative study outlines the preference evidence collected regarding Canadian cancer survivors’ decisions to manage their symptoms with cannabis to inform a DCE quantitative survey. It contributes to transparent reporting of qualitative work in DCE development and to understanding cancer survivors’ preferences regarding medicinal cannabis consumption under legalization.
Supplementary information
Key Points for Decision Makers |
This article describes a qualitative research approach to developing a preference survey aimed at understanding Canadian cancer survivors’ decisions to manage their symptoms with cannabis in the context of legalized cannabis consumption. |
Qualitative research is foundational to achieving a discrete choice experiment (DCE) design that is meaningful to patients and stakeholders, context sensitive, and amenable to policy formation. |
Our findings showed that cannabis was widely believed to have therapeutic effects. However, the stigma often associated with cannabis use in social and healthcare contexts left some survivors without medical guidance to support their decisions regarding cannabis consumption and symptom relief. |
In jurisdictions such as Canada, where recreational cannabis consumption was recently legalized, this information can be used to support person-centered care and shared decision making between patients and physicians in oncology and health policy. |