Shaping Patients' Perspective of Medical Marijuana for Glaucoma Treatment

In this issue of JAMA Ophthalmology, Belyea and colleagues1 provide insight into the perspectives of patients with glaucoma on the use of marijuana for the potential treatment of their disease. This insight is undoubtedly timely given the recently expanding legalization of medical marijuana throughout theUnitedStates. As Belyea et al1 acknowledge, this strong public-driven shift toward legalization of medical marijuanaseemstoclashwith the relativelyweakscientificevidence supporting its therapeutic use, particularly for treatment of glaucoma. However, more than 20 states have now legalized medical marijuana, creating a supportive landscape for its use in growing segments of the population. Within the realm of treatment of glaucoma and certain other diseases, this clash between science and popular politics places almost an unprecedented importance on the patientperspective.Thisclash is superimposedonanalreadysubstantial bodyof literaturehighlighting the relevanceofpatient perception in health care. More than 2 decades ago in 1988, thePicker/CommonwealthProgramforPatient-CenteredCare (thepresent-dayPicker Institute) coined thenowwidelypopularized term patient-centered care to emphasize the importance of understanding the patient experience within an increasingly intricate and fragmented health care system.2 Indeed, for many patients with glaucoma, the legalization of medicalmarijuanamakes thehealthcare landscapemorecomplex than ever before, particularly as more states pass legislation legalizing recreationalmarijuanaand increasingly grant patients access to the drugwithout prescriptionswritten by a physician. Even now, despite continued widespread restrictions on recreational use, marijuana is the most widely accessed illicit substance in the United States.3 In this intricate health care landscape, Belyea and colleagues1 have identified the timeliness of highlightingpatient perceptions aboutmarijuana.Although, as thearticle suggests, it isnotenough to simply uncover these perceptions, the physician must then respond and tailor his or her practice accordingly. This finding raises the question: What is the best response to the insights uncovered in the current study? First, let us consider the findings. Using an expertreviewed questionnaire andmultivariable regression model, Belyea andcolleagues1 identified factors that contribute topatients’ intentions tousemedicalmarijuana for glaucoma treatment. Younger age, lower level of education, and prior marijuana use were positively correlated with intention to use marijuana for glaucoma treatment. Several patient perception factors also demonstrated significant positive correlations with the intention to use medical marijuana, including notions supporting legalizationofmedicalmarijuana, falsebeliefs regardingmarijuana’sefficacy inglaucomatreatment, and disregard for the costs of its purchase. Arguably ofmost interest, however, patient satisfactionwith current glaucomamanagement exhibited a strong negative correlation with the intention tousemarijuana for glaucoma treatment, highlighting an important aspect of patientperception in themedicalmarijuana landscape that has relatively little to dowith opinion or knowledge of the drug itself. In the discussion, the authors focus on how best to alter these favorable perceptions ofmarijuana and shift patient focus back to evidence-based therapies. However, their strategies only minimally take into account the variable of patient satisfaction. Instead, Belyea et al1 focus heavily on altering perceptions of the alternative therapy itself via ample patient education. The discussion primarily addresses the inaccurate beliefs patients harbor regarding marijuana; using an approach that knowledge gives patients the power to choose the best therapy, the authors outline several methods for providingpatientswith informational resources toguide them toward conventional treatments. However, this singular education-oriented approach fails to directly address patients’ overall frustrationwith current care and treatment options. It seems most logical that, to effectively influence patients’ intentions towardmarijuanause, ourultimate strategywill need to stretch beyond patient education and address the roots of this dissatisfaction. The studybyBelyeaet al1 doesnotoutline the specificmotivators behind this patient dissatisfaction, which interestingly seems to exist independently of glaucoma severity. That said, while it is unclear precisely what is driving this dissatisfaction, we can assume, based on existing studies, that it is likelymotivatedbyavarietyof patient-centric elements. Prior literature has revealed that patient satisfaction is dependent on a combination of personal, cultural, socioeconomic, and health-related factors that are all superimposedonpast experienceswithhealth care services.4However,morenotably, the literature has well demonstrated that to take into account all these contributing factors, physiciansmust offer not only informational guidance but also emotional support to increase patient satisfaction levels. The Picker Institute conducted a multiyear research project that sought to identify indicators of high-quality care from thepatient perspective. Clear, highgrade information and education were appreciated by patients, but amongother equally important factorswere a physician’s ability to convey respect andempathy for thepatient’s needs andvalues, aptitude for appropriately engaging thepatient’s family members and friends, and capacity to provide emotional support and alleviate fear and anxiety.2 Comprehensive attention to all of these factors forms the basis of patient-centered care and its promotion of patient satisfaction. Related article page 259 Survey of Patients onMarijuana Use to Treat Glaucoma Original Investigation Research