Perceptions and Preoccupations of Patients and Physicians Regarding Use of Medical Cannabis as an Intervention Against Chronic Musculoskeletal Pain: Results from a Qualitative Study.

Objective: Explore perceptions and preoccupations regarding use of medical cannabis against chronic musculoskeletal pain, among patients and physicians. Design: Qualitative study using interviews with patients and physicians, based on the Theory of Planned Behavior (TPB). Setting: The study was conducted in Quebec, Canada, in spring 2020. Subjects: We included 27 adult patients and 11 physicians (GPs, anesthesiologists, psychiatrists, and a rheumatologist); the mean age of patients was 48.2 years; 59.3% of patients and 36.4% of physicians were women; 59.3% of patients used no medical cannabis at the time of study; 45.5% of physicians had never authorized it. Methods: Semi-structured interviews were conducted, transcribed and for the qualitative analysis codes were developed in a hybrid, inductive and deductive approach. Guided by the TPB, facilitators and barriers, perceived benefits and harms, and perceived norms that may influence cannabis use or authorization were documented. Results: Although medical cannabis is an interesting avenue for the relief of chronic musculoskeletal pain, doctors and patients agreed that it remained a last line option, due to the lack of scientific evidence regarding its safety and efficacy. The norms surrounding medical cannabis also play an important role in the social and professional acceptance of this therapeutic option. Conclusion: Medical cannabis is seen as a last line option among interventions in the management of chronic pain, and attitudes and prior experiences play a role in the decision to use it. Study results may contribute to improved shared decision making between patients and physicians regarding this option.

De l'aide médicale à mourir au Québec : une analyse du contexte et de la pratique infirmière en soins palliatifs.

Context : Quebec's "medical aid in dying" (MAID) is a medical intervention mostly practiced in palliative care units. MAID results from a deep revolution within Quebec's ethics regarding end-of-life care. However, there is a lack of empirical studies regarding nursing practice within the context of MAID.Aim : To conduct a literature review of legal and scientific data, as well as data from the media, related to the patient experience of nursing practices in palliative care for patients in Quebec who have requested MAID.Methodology : Burn, Grove, and Sutherland's methodology allowed us to extract and analyze six empirical studies from the CINAHL database. We also analyzed 17 media articles and one legal paper that documents the legalization of MAID in Quebec.Results : There has been a strict law governing MAID since 2015, but some major social events and issues have recently allowed for the expansion of the practice. The literature review allowed us to identify two themes : 1). the nature of nursing practice within MAID, and 2). the need for nursing education that addresses the complex aspects of MAID.Discussion and conclusion : We discuss the effects of the domination of the biomedical narrative on MAID and the collapse of Quebec's health system, which both negatively impact nursing practice in the context of MAID.