JMIR Publications

ABSTRACT

Background:

Conventional treatments have been frequently reported to offer partial relief for some individuals managing arthritis pain and related symptoms, leading many to consider alternative options such as cannabis. Informed decision-making about cannabis use requires patients to weigh potential benefits and risks in light of their personal values and preferences.

Objective:

We aim to develop a theory-driven, evidence-based, user-centred decision support intervention [DSI] that promotes shared decision-making [SDM] and supports older adults in making informed decisions about cannabis use. As part of this process, we will explore whether older adults prefer a digital or non-digital format for the DSI.

Methods:

The Ottawa Decision Support Framework [ODSF], the International Patient Decision Aids Standards [IPDAS], and the User-Centeredness approach guided the DSI development process in four phases. Phase I: scoping reviews to explore the development of DSIs and the literature addressing cannabis use in arthritis, guided by the PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] framework. Phase II: semi-structured interviews were conducted with older adults living with arthritis to explore their decisional needs. Phase III: semi-structured interviews were conducted with clinicians to explore how they can participate with their patients during cannabis use decision-making. Reflexive thematic analysis was chosen as the analytic approach for this study. In each Phase, the sample size will be determined by reaching data saturation. Phase IV: An "alpha" testing phase will be conducted, during which a prototype of the decision support intervention will be evaluated for usability and acceptability through think-aloud cognitive methods with patient partners and advisory board members. Based on the feedback received, the prototype will be refined accordingly. Subsequently, a future study involving a "beta" testing phase will be conducted using a quasi-experimental before-and-after study design. The University of Alberta Human Research Ethics Board approved this study. This protocol is based on the latest version of the ethics application, dated December 14, 2024 [Pro00133420 ].

Results:

Phase I is completed; it showed that the most commonly reported development bases for SDM tools were the ODSF and IPDAS criteria, reported in 16% and 53% of tools, respectively. Phases II and III are still in progress. Preliminary findings showed that informational support is needed for patients and clinicians. Phase IV will be initiated when findings from phases II and III are available.

Conclusions:

This protocol outlines the systematic development and preliminary validation of a patient-centred DSI to support shared decision-making about medical cannabis for arthritis pain. Findings will inform both the refinement of the tool and whether a digital or non-digital format is most appropriate for older adults, guiding its readiness for beta testing and future implementation. Clinical Trial: N/A