Evidence map›Paper›PMID 35292477›Full record

ArticleCMAJ open

Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study.

Margot Gunning, Ari D Rotenberg, Lauren E Kelly, Bruce Crooks, Sapna Oberoi, Adam L Rapoport, S Rod Rassekh, Judy Illes

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.6field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 10 citations in OpenAlex.

  1. Review
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Margot GunningNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Ari D RotenbergNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Lauren E KellyNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Bruce CrooksNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Sapna OberoiNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Adam L RapoportNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
S Rod RassekhNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC.
Judy IllesNeuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC jilles@mail.ubc.ca.
Izaak Walton Killam Health Centre · CAUniversity of Manitoba · CAUniversity of British Columbia · CAUniversity of Toronto · CA

Funding

CIHR 707031
6 · The paper itself

Abstract

backgroundThe use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization.

methodsWe sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods.

resultsWe conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards.

interpretationClinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.

Indexed as

Medical MarijuanaPhysiciansAdolescentCanadaChildCommunicationHumansQualitative ResearchMedical Marijuana

Identifiers

PMID35292477
PMCPMC8929429
OpenAlexW4220850392

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.