What Hospice Providers Want to Know about Medical Cannabis

Transcription

1 What Hospice Providers Want to Know about Medical Cannabis Kelly S. Mendoza, MS, PharmD 1 Russell Hilliard, PhD, LCSW, LCAT, MT-BC, CHRC 2 Mary Lynn McPherson, PharmD, MA, BCPS, CPE 1 1 University of Maryland School of Pharmacy 2 Seasons Hospice & Palliative Care Hospice and Palliative Care Network of Maryland Annual Conference: E-Poster Presentation; November 16, 2016

2 Background 25 states and the District of Columbia have legalized or decriminalized cannabis (marijuana) for medical use 1 Federal DEA Classification: Schedule I Arguments for re-classification: evidence pointing to improvement of palliative care and reductions in opioid-related morbidity 2 benefits of medical cannabis (MC) shown in nausea and vomiting associated with cancer chemotherapy, cachexia associated with HIV/AIDS, and certain kinds of neuropathic pain or treatment-resistant cancer pain 3-6

3 Background

4 Purpose The aim of this portion of the study is to perform a needsassessment survey that will determine the knowledge, skills, and attitudes regarding the use of medical cannabis by hospice providers (physicians, pharmacists, nurse practitioners, chaplains, social workers, etc)

5 Methods An educational needs assessment survey was distributed to staff of a large national hospice and palliative care program to determine knowledge, skills, and attitudes regarding medical cannabis

6 Results Survey Response Rate: 85.04% (290/341) Survey availability: 10 days All 19 states represented Majority: IL (12.76%), MD (12.07%), CA (12.07%), MI (11.03%) Professional Disciplines - majority RN (58.28%) Other (22.41%) Social Work (11.38%)

7 Results 47.9% worked in hospice/palliative care 0-3 years 71.03% not hospice/palliative care certified Uses of Cannabis in the State in Which You Practice Medical Use (56.6%) Recreational Use (1.0%) Both (5.5%) Neither (24.8%) I Don't Know (12.1%)

8 A. I feel confident in my knowledge of the chemical components and their mechanisms of action B.I feel confident in my knowledge of the medical uses (indications) of cannabis C. I feel confident in my knowledge of the different formulations and how to teach patients to use them D. I feel confident in my ability to provide recommendations to prescribers about accurate dosing cannabis E. I am aware of the medical evidence supporting the use of cannabis to palliate symptoms F. I feel confident in my knowledge of side effects and how to manage them G. I feel confident in my ability to talk to my patients about medical cannabis H. I feel comfortable talking to my patients about medical cannabis I. I feel confident in my ability to manage the drug regimen of a patient who is taking medical cannabis J. I feel confident in my ability to protect myself in a home where medical cannabis is being used Current Knowledge Regarding the Use of Medical Cannabis Yes No Unsure

9 A. Common name(s) for medical cannabis B. Chemical components of medical cannabis and their mechanisms of action in symptom management C. Indications for the use of medical cannabis in the hospice setting D. Available formulations of medical cannabis & how to use them E. How to dose medical cannabis F. Side effects of medical cannabis and how to manage them G. Potential drug interactions when using medical cannabis H. Strategies to protect myself when I am in a home where medical cannabis is being used Importance of Proposed Topics for Training Module Very Important Important Not Important

10 Conclusions/Next Steps Most providers do not feel confident in current knowledge Develop training module with six topic domains Pharmacology of cannabis Evidence/Indications for cannabis use Formulations and dosing Adverse Effects and Safety Drug Interactions Patient Counseling Training module will be offered with pre-/post- evaluation assessing knowledge, skills, and attitudes

11 Questions

12 References 1. State Marijuana Laws Map. Accessed November 13, Carter GT, Flanagan AM, Earleywine M, et al. Cannabis in palliative medicine: improving care and reducing opioid-related morbidity. Am J Hosp Palliat Care. 2011;28(5): Savage SR, Romero-Sandoval A, Schatman M, et al. Cannabis in pain treatment: clinical and research considerations. J Pain. 2016;17(6): Johannigman S, Eschiti V. Medical use of marijuana in palliative care. Clin J Oncol Nurs. 2013;17(4): Strouse TB. Pot in palliative care: what we need to know. J Palliat Med. 2015;18(1): Bar-Sela G, Vorobeichik M, Drawsheh S, et al. The medical necessity for medicinal cannabis: prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care. Evid Based Complement Alternat Med. 2013;

13 What Hospice Providers Want to Know about Medical Cannabis Kelly S. Mendoza, MS, PharmD 1 Russell Hilliard, PhD, LCSW, LCAT, MT-BC, CHRC 2 Mary Lynn McPherson, PharmD, MA, BCPS, CPE 1 1 University of Maryland School of Pharmacy 2 Seasons Hospice & Palliative Care Hospice and Palliative Care Network of Maryland Annual Conference: E-Poster Presentation; November 16, 2016