Development of a Decision Aid to Support Shared Decision-Making on Cannabis Use for Arthritis: Protocol for a...

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.

This study aims to systematically develop a theory-driven, evidence-based, user-centered decision aid (DA) for older adults with arthritis, considering medical cannabis.

The Ottawa Decision Support Framework, the International Patient Decision Aids Standards, and the User-Centeredness approach guided the DA development process in 4 phases. Phase 1 (completed) involved scoping reviews to explore the development of shared decision-making (SDM) tools and the literature addressing cannabis use in arthritis, guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Phase 2 (in progress) consists of semistructured interviews that are conducted with older adults living with arthritis to explore their decisional needs. Phase 3 (in progress) involves semistructured interviews that are conducted with clinicians to explore how they can participate with their patients during cannabis use decision-making. For phases 2 and 3, recruitment has been initiated in a large urban center in Alberta, Canada. Purposive sampling is conducted, and the sample size will be guided by the principle of information power. Phase 4 (not initiated yet) will involve the development of the DA and alpha testing to explore qualification as a DA and acceptability with advisory board members, including patients and clinicians who participate in the development process. Based on the feedback received, the prototype will be refined accordingly. Subsequently, a future study involving a beta testing phase will be conducted to evaluate the usability, accessibility, and comprehensibility of the DA among naive users. 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).

This project was funded in November 2022. Phase 1 is completed; the advisory board is assembled. Two scoping reviews have been published. The first review showed that the most commonly reported development bases for SDM tools were the Ottawa Decision Support Framework and International Patient Decision Aids Standards criteria, reported in 16% and 53% of tools, respectively. The second review highlighted limited high-quality evidence addressing medical cannabis use for arthritis. Phases 2 and 3 have been initiated. Phase 4 will be initiated when the findings from phases 2 and 3 are available. As of November 2025, we have recruited 10 patients for phase 2 and 7 clinicians for phase 3.

This protocol outlines the systematic development of a patient-centered DA to support SDM about medical cannabis for arthritis pain. The findings will show the feasibility of development and inform the refinement of the DA, guiding its readiness for beta testing and future implementation.