Department of Health Management & Policy, 4083University of Iowa, Iowa City, IA, USA.
Department of Medicine, 14681University of Illinois at Chicago, IL, USA.
Am J Hosp Palliat Care. 2022 Mar;39(3):345-352. doi: 10.1177/10499091211018655. Epub 2021 May 18.
Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care.
Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( = 19) or planning to enroll ( = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care.
In our sample, cancer patients (), and those who used the fast-track application into the IMCP () were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition (), or entered the IMCP via the fast-track ().
Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.
在 2013 年至 2019 年期间，伊利诺伊州将大麻的使用权限限制在参加伊利诺伊州医用大麻计划 (IMCP) 的认证患者范围内。2016 年，该州为末期患者建立了快速通道。医用大麻 (MC) 的益处对临终患者有明确的影响。然而，对于末期患者相对于支持性护理如何使用医用大麻，人们知之甚少。
从已经登记（= 19）或计划登记（= 323）接受临终关怀的 342 名末期患者中匿名收集了横断面调查数据。逻辑回归模型比较了样本中计划进入临终关怀与实际进入临终关怀的患者、姑息治疗与临终关怀的使用情况、标准护理与非临终姑息治疗的使用情况。
在我们的样本中，癌症患者（）和那些通过快速通道申请进入 IMCP（）的患者更不可能登记进入临终关怀。与姑息治疗患者相比，临终关怀患者不太可能报告癌症是他们的合格条件（），也不太可能通过快速通道进入 IMCP（）。
鉴于在相当大的临终关怀样本中临终关怀的登记率较低，大麻的使用可能是替代支持性护理形式的一种选择，如临终关怀和姑息治疗。临床医生应在与患者讨论大麻使用的同时，还应开展临终关怀规划讨论，将其作为一般护理计划的重要组成部分。
