Social Marketing to Promote Medical Marijuana Use: The Basis of PatientCentered Palliative Care

Abstract

Introduction and Objective:  Thailand initiated a policy to promote the use of medical marijuana in 2019, with the Ministry of Public Health ordering the opening of medical marijuana clinics in the hospitals under the Ministry of Public Health covering all provinces, with a focus on using it in palliative care patients. Results of medical marijuana operations in Phetchabun province found that doctors prescribed medical marijuana for palliative care patients very rarely, and the trend is continuously decreasing. Therefore, researchers are interested in finding ways to encourage doctors to prescribe medical marijuana for palliative care patients. This qualitative study aimed to analyze the situation of medical marijuana use in palliative care patients from the perspectives of medical personnel and palliative care patients, including the development of a model to promote the use of medical marijuana in palliative care patients in the hospital of Phetchabun province by using a social marketing concept.

Method:  Perspective of medical personnel, Data collected through focus group discussions with 3 medical personnel in the target hospitals: pharmacist, nurse and Thai traditional doctor. In-depth interviews were conducted with one doctor in charge of the palliative care clinic. The focus group and in-depth interview questions consisted of 17 open-closed questions adapted from the Behavior Change Wheel and Behavioral Economics theories. It is divided into 5 categories according to the factors that affect the use of medical marijuana. Including policy factors service system factors economic factors medical personnel factors and patient factors. In terms of patient perspectives, data were collected through in-depth interviews with 11 palliative care patients aged 20-60 years, divided into 6 patients who had received medical marijuana and 5 patients who had not received medical marijuana and can communicate information. There are 12 in-depth interview questions, referring to the SERVQUAL service quality measurement form. It consists of questions in 5 areas: tangibility of the service, reliability of medical marijuana use, and responsiveness of patients’ needs for medical marijuana use, providing patients with confidence in their treatment (assurance) and knowing and understanding the patient (empathy). Content analysis of the study results was performed using the Atlas.ti Version 24 program. The data obtained from the study results were used to determine strategies to promote the use of medical marijuana with the social marketing.

Results:  Medical personnel are still not confident in the effectiveness and safety of medical marijuana because there is a lack of reliable information, which is contrary to the opinions of patients who are interested in the use of medical marijuana that believe the medical marijuana make them recovered from disease. The information obtained from this study can be used to determine marketing strategies (6Ps marketing mix) to promote the use of medical marijuana as follows: (1) Have a manual on the use of medical marijuana for medical personnel and the public. (2) Communicate information on the effectiveness of medical marijuana use to doctors so they are aware of the value of medical marijuana use. (3) Extend the hours of medical marijuana clinics. (4) Have a process for providing knowledge to relevant personnel, such as lessons learned from a best practice on medical marijuana use. (5) Create a communication channel between administrators and practitioners. (6) Have a system for giving rewards. (7) Use the Change choice defaults approach, such as making a pop-up to choose to use medical marijuana in the medication ordering program. (8) Have a system for searching and screening patients who meet the criteria to receive medical marijuana as compensation. (9) There is a good service model for medical marijuana clinics. (10) There is a compensation policy.

Discussion:  This study revealed that patients have high expectations for the use of marijuana for medical treatment, while medical personnel are aware of the safety of marijuana use with patients, but lack clear guidelines for its use, which makes them hesitate to decide to prescribe marijuana to patients. It can be seen that promoting the use of medical marijuana is still a matter of limitations, both in terms of lack of reliable medical marijuana use data and personnel readiness, which is a challenge for those responsible for overseeing medical marijuana policy.

Conclusion and Recommendation:  Promoting medical marijuana policy requires cooperation from many relevant sectors, including government agencies private sector educational institutions and the hospitals to obtain information on the safety and effectiveness of medical marijuana use. Therefore, if we want to promote the increased use of medical marijuana, here are some suggestions: (1) Related people in pushing for drug policy should be given priority on the safety of drug use. (2) Promotion of medical marijuana policy should be promoted and communicated in the same direction, both among medical personnel and the public sector.