Problems and Barriers in Providing Medical Cannabis Services for Palliative Care Patients: Perspectives of Healthcare Professionals in Pattani Province

Abstract

Objectives: To examine the service delivery process, problems and barriers within medical cannabis service system for palliative care patients in Mueang District, Pattani Province, and to propose approaches for improving the service. Methods: The researchers in-depth interviewed 15 personnel involved in medical cannabis services and palliative care in Mueang District, Pattani Province and observed service delivery. The researchers also conducted a focus group discussion among 8 administrators and practitioners to propose system improvement approaches. Data were collected from March to September 2024 and analyzed using thematic analysis. Results: The medical cannabis clinic operates as a multidisciplinary service system, bridging hospitals and sub-district health promoting hospitals (SHPHs). The services encompass screening, diagnosis, prescribing, counseling, and follow-up, with information shared with the community to ensure patients receive appropriate and continuous care. Problems in the medical cannabis service system were categorized into 7 aspects: 1) personnel: limitations in knowledge, experience, confidence, and insufficient workforce 2) medication: short shelf life of medical cannabis, difficulty in using drop formulations, and discontinuation of drug supply 3) treatment guidelines: medical cannabis is not considered a first-line treatment, and practice guidelines conflict with policies aimed at increasing access 4) physical facility and environment: The current setup is not conducive to service delivery. 5) service system: lack of coordination among personnel and between hospitals and SHPHs 6) public relations: limited publicity and lack of local-language media and 7) patients receiving service: declining numbers, limited health literacy regarding cannabis, behaviors causing discomfort to healthcare staff, refusal of cannabis medications, and cannabis use conflicting with patients' personal beliefs. Approaches for improving medical cannabis services comprise fostering literacy and confidence among healthcare personnel, improving workflows and inter-organizational integration, upgrading service facilities, strengthening medication management systems, increasing public awareness, promoting cannabis literacy among the public, and conducting further research on medical cannabis use. Conclusion: Seven key problem areas were identified in medical cannabis services. Improvement should focus on enhancing the knowledge and confidence among healthcare personnel, ensuring readiness in terms of workforce, medications, and service facilities, improving service processes, increasing public awareness, and promoting cannabis literacy and public trust to support the appropriate and safe use of medical cannabis.