KSA of Cannabis in Hospice: An Educational Intervention

Topic: Education Strategies

Currently, 28 states and the District of Columbia have legalized or decriminalized cannabis (marijuana) for medical use. While medical cannabis (MC) remains illegal from a federal perspective, providers who practice in the states that have legalized it are faced with questions regarding the benefits and risks of MC. While MC has been shown to be beneficial for some indications, it is unclear how comfortable hospice providers are with the concept of medical cannabis.

The aim of this study is to determine changes in knowledge, skills, and attitudes (KSA) of hospice providers regarding the use of medical cannabis in the hospice population. The current study expands upon previous research by identifying medical cannabis educational needs among hospice practitioners and creating and evaluating an online course designed to meet those needs. Attitudes, skills, and knowledge were analyzed in six learning domains: pharmacology, evidence/indications for use, formulations and dosing, adverse effects/safety, drug interactions, and patient counseling. Participant demographics were analyzed using descriptive statistics. To detect any differences between pre- and post-survey, a paired t-test was used to reduce inter-subject variability. In addition, the association of mean scores of each domain in the post survey according to demographic characteristics was analyzed using an independent t-test. Analyses were performed with SAS version 9.4 (SAS Institute, Cary, NC).

A total of 94 hospice providers representing 16 states participated in the survey with the majority from Maryland (41.5%). 76.6% of respondents were nurses, with 45.7% of participants having practiced in hospice less than 3 years. Attitudes surrounding the six domains were overall positive and did not change significantly after the educational intervention (pre = 2.86/post = 2.84, p=0.41). Perceived skills in the six domains increased significantly after the online course, with average responses improving from 1.24 to 2.15 (p < 0.0001). Knowledge significantly improved with the educational intervention, with 41% of respondents answering correctly prior to the course, and 78% of respondents answering correctly post-course (p < 0.0001). Post survey mean scores for attitudes and knowledge in each domain were not significantly different between nurses and social workers. Perceived skills in 2 domains (formulations/dosing and patient counseling) were significantly different between nurses and social workers in the post test. There was a significant difference in attitudes in all domains between participants who have practiced in hospice < 3 years or > 4 years, with those practitioners with less experience having more positive attitudes about MC, however, there was no difference in perceived skills or knowledge. There was no difference in KSA between respondents who are board certified in hospice medicine versus those who are not.

In conclusion, providers’ attitudes regarding the use of medical cannabis in hospice did not significantly change after the education intervention and was overwhelmingly positive both before and after. Both the perception of skills and direct knowledge was significantly increased after the education intervention, with providers reporting more positive skills and >75% of respondents answering questions correctly after the intervention.


  • Kelly Mendoza, PharmD
  • Pain Management Clinical Pharmacist
  • University of Maryland School of Pharmacy
  • 20 N. Pine Street
  • Baltimore, MD 93291


  • Mary Lynn McPherson, PharmD, MA, MDE, BCPS, CPE

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