MedicalResearch.com: What is the background for this study?
Response: The background to this study was a personal interest in behavioural science. I am often intrigued as to why health professional behave the way they do. Studies exploring health professional behaviour are seldom complete or comprehensive, however.
Medicinal cannabis presents an interesting case point to explore health professional behaviours due to its topical nature. The socio-political discussion surrounding medicinal cannabis is often quite different from the medical discussion, yet for legal and regulated access to be achieved across most jurisdictions, a health professional is required to be involved in that process. Simply, if health professionals are not willing to behave, the delivery of medicinal cannabis does not occur. For purposes of transparency, I neither support or reject the use of medicinal cannabis and this paper has nothing to do improving or reducing access. This paper is about beginning to understand health professional behaviours within the context of medicinal cannabis. Yet, if we hope to change practice in the future, by definition, we need to change behaviour. We cannot change behaviour without first understanding the behaviour in context.
MedicalResearch.com: What are the main findings?
Response: This systematic review pulled together all existing literature looking at the delivery of medicinal cannabis. Delivery includes the authorisation (prescribing/recommending) and supply (dispensing/administration).
The main findings are that universally, these studies simply explore knowledge, beliefs and concerns. Knowledge – how much do health professionals know about medicinal cannabis? Beliefs – how do health professionals feel about medicinal cannabis? Concerns – what are health professionals worried about relative to medicinal cannabis? We note that although health professionals were relatively supportive of medicinal cannabis, it is important to acknowledge the fundamental difference between being supportive and being responsible for service delivery. Health professionals were often lacking knowledge across all domains of expertise. Health professionals were also quite concerned, principally around psychiatric adverse effects. There was also concern for diversion and recreational misuse of prescribed products. It is interesting to place these concerns in the context of a lack of knowledge and education, however. Are these concerns evidence-based or the product or something more anecdotal?
A secondary finding is that all included studies used implicit common-sense models of behaviour to explore their behaviours of interest. Some going as far to provide recommendations based on their findings. Yet, as above these studies are not complete or comprehensive in their exploration of the factors underpinning health professional behaviour. They are providing solutions without first understanding the complexity of the entire problem. Think of a picture, made up of lots of puzzle pieces. If we only have 3 of the puzzle pieces, we cannot fully understand that the picture looks like. Here, we have only offered insight into knowledge, attitudes and beliefs. Human behaviour is far far more complex than that. This is the most interesting finding I believe. These findings tells us that we still know little to nothing about the factors that underpin health professional behaviour relative to medicinal cannabis. We still no little to nothing about the ‘problem’ facing health professionals and patients alike. This is where more research is required. Not simply on repeating partial descriptions of health professional behaviour.
MedicalResearch.com: What should readers take away from your report?
Response: I think this builds into the interesting and topical discussions surrounding medicinal cannabis. Where many people are discussing the positive and negative health effects of cannabis, very few are discussing health professional behaviour. Yet, it is still part of the entire discussion. As I stated at the beginning, if health professionals are not willing to behave, service delivery will be compromised. If we want to be capable of guiding delivery using robust, evidence-based strategies, we need to understand this behaviour. This is something that we really just don’t fully have a grasp of yet. I think this is just as important as understanding the positive and negative effects of cannabis.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This systematic review provided an international overview of health professionals. The results appeared relatively consistent regardless of jurisdiction. We have used this as a foundation upon which to move into a secondary phase of research. Being Australian, my work focuses largely on Australian health professional behaviour. We are using structured theoretical frameworks based in behaviour and implementation science to explore the factors the underpin the delivery of medicinal cannabis. These results will allow the future development of strategies to alter behaviour according to what is required (something I wish not to speculate upon here). Although these results are not directly translatable outside of Australia given the massive heterogeneity in legislation that exists on an international level – this work will provide a template for others to assess the delivery of medicinal cannabis moving forward. Behaviour science is an area that is of massive importance yet, is seldom considered relevant. My aim is to make it relevant in this space. Specifically, with respect to medicinal cannabis, but more broadly by considering other socio-politically polarising topics where health professionals are placed in the crosshairs of service delivery.
MedicalResearch.com: Is there anything else you would like to add?
Response: I have nothing else to add. As per the publication the research team declare no conflicts of interest. As I mentioned above, I neither support or reject the use of medicinal cannabis. This work has nothing to do with whether it should or shouldn’t be used. This work is placed in behaviour science and seeks to understand a health professionals behaviour when presented with medicinal cannabis, nothing more, nothing less.
Thanks for the opportunity to comment.
Kyle M. Gardiner, Judith A. Singleton, Janie Sheridan, Gregory J. Kyle, Lisa M. Nissen. Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis – A systematic review. PLOS ONE, 2019; 14 (5): e0216556 DOI: 10.1371/journal.pone.0216556
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