Are Patients Who Trust Their Providers More Likely to Use Medical Cannabis?

Abstract

Background: Trust is an essential element of the patient-provider relationship and has been associated with better patient outcomes; however, it is not clear what role trust might play in influencing patients’ willingness to try medical cannabis when it is recommended in states where it has been legalized for medical use. Objectives: To explore the relationship between peoples’ trust in their health care clinicians and hospitals and their willingness to consider using medical cannabis if it is recommended by their clinician or hospital. Methods: We conducted an anonymous, cross-sectional, online survey of adults who participated in the Qualtrics Research Company Panel and used quotas to match our sample to the characteristics of the U.S. population. Results: We received 1120 completed surveys. The vast majority of respondents (84.4%) reported having a regular provider and 42.5% of those who reported having a regular physician and nearly 35.6% of those who reported having another regular provider (e.g., nurse practitioner, physician assistant) reported that they “completely” trusted that clinician. Those who reported “completely” trusting their usual clinician were more than twice as likely to report they would definitely use medical cannabis if recommended (42.5% vs 20.6%). Similarly, the greater respondents’ trust in hospitals, the more likely they were to report a willingness to consider using recommended medical cannabis. Conclusion: Patient trust in their health providers is related to patients’ willingness to use recommended medical cannabis.

Keywords

trust in physician cannabis marijuana patient-provider relationship interpersonal relationships physician-patient communication

Introduction

Trust—defined as “the acceptance of a vulnerable situation in which the truster believes that the trustee will act in the truster’s best interests.”^1(p.125)—is an essential element of the patient-provider relationship. Beyond its inherent benefits, trust predicts a variety of positive health outcomes. For example, trust has been associated with better patient engagement,² satisfaction,^3-5 patient adherence,^4,6 use of recommended preventive services,⁷ self-rated health,⁸ control of chronic conditions,⁹ and utilization patterns including fewer missed visits and less delayed care.¹⁰ A 2017 meta-analysis of 47 studies examining the association between trust in health care professionals and health outcomes including objective (e.g., blood pressure, glycemic control), observer-rated (e.g., diagnosis), and self-rated subjective (e.g., satisfaction, quality of life, health promotion) measures found evidence of positive correlations between a variety of outcomes. Stronger correlations were found between trust and self-rated subjective health outcomes and behaviors than objective or observer-rated outcomes.¹¹

Despite what is known about the importance of trust between patient and clinician, including its positive influence on medication adherence, it is not clear what role trust might play in influencing patients’ willingness to try medical cannabis if it is recommended by a provider in a state where it has been legalized. This is a delicate matter—mostly because cannabis remains illegal at the federal-level¹² and there is often stigma associated with its use.^13,14 In fact, even in states that have legalized cannabis for medical use, studies have found that patients who use the drug experience high levels of psychological distress and stress related to criminality and are subjected to human rights violations by law enforcement (e.g., searches, job loss, home eviction).^15,16 For these reasons, taking cannabis is unlike taking any other prescription medication.

At the same time, Americans’ self-reported use of cannabis has increased dramatically over the last decade—from 7.5% to 13.5% among people aged 12 or older from 2013 to 2020¹⁷—and their attitudes about its legalization are more accepting and permissive.¹⁸ Given the importance of trust in influencing favorable patient outcomes and states’ rapid movement towards legal cannabis environments, it is important to understand whether patient trust might also play a role in patients’ willingness to use medical cannabis. This paper explores this phenomenon. Specifically, we explored the relationship between peoples’ trust in their health care providers (both their regular health care professional and their hospital) and their willingness to consider using recommended medical cannabis.

Methods

We conducted an anonymous, cross-sectional, online survey of U.S. adults (age 18 or over) who participated in the Qualtrics Research Company Panel. The Qualtrics Panel has been found to be reflective of national demographics,¹⁹ and we used quotas to more closely match our sample to the demographic characteristics of adults in the U.S. based upon gender, race/ethnicity, age, educational level, and region. We recruited a total sample of 1120 respondents who completed the survey between September and October 2021. Electronic consent was obtained. The research was approved by the Baruch College, City University of New York, Institutional Review Board.

The survey asked respondents about whether they had a regular provider, and if so, whether it was a doctor or another type of clinician. Based on the response, respondents were asked how much trust they had in their regular doctor or clinician, and those without a regular health care provider were asked about their trust in doctors, in general. All respondents were also asked “In general, how much do you trust hospitals?”

We also asked respondents their opinions about the legalization of cannabis as well as their ever-use and past-month cannabis use. Among those who reported past-month cannabis use, we asked about the frequency of use (i.e., number of days), route of administration (e.g., smoke, eat, vaporize), and reason for use (medical, recreational, both).

Respondents who reported not using cannabis in the past month were asked two additional questions about their willingness to use medical cannabis if it was recommended. One question focused on their willingness to use cannabis if it was recommended by their health care professional (clinician or a doctor, depending on the type of usual clinician or if they had one). Another question asked about their willingness to use medical cannabis if it was recommended while hospitalized.

Using descriptive statistics, we examined the prevalence of responses to each item. We created an aggregate measure of trust in clinicians by combining responses to questions about respondents’ trust in their regular doctor or health care professional, or for those who did not have a regular clinician, their trust in physicians, in general. We also created an aggregate measure of willingness to use recommended medical cannabis by combining responses to questions about respondents’ willingness to consider using the drug if recommended by their regular doctor, regular clinician, or a doctor (if they did not have a regular provider).

We used bivariate chi-square tests to separately examine the relationship between respondents’ trust in their clinician or trust in hospitals, in general, and their willingness to consider using recommended medical cannabis. We conducted two supplemental analyses examining these same relationships (i.e., trust in clinician or hospitals and willingness to consider using recommended cannabis) among the subsample of respondents who (1) reported never using cannabis and (2) reported not using cannabis in the past month and living in states that had legalized medical cannabis. All P-values were 2-tailed, and P ≤ .05 was considered statistically significant. Stata/SE version 15.1 was used for all analyses.²⁰

Results

We received 1120 completed surveys. The majority of respondents (51.0%) were between 34-65 years of age (Table 1). Nearly 15% were 65 years old or older. Most respondents had at least some college (64.8%) while 4.1% had not graduated from high school. One-third of respondents reported incomes of less than $30,000. The vast majority (89.9%) reported some health insurance coverage and nearly four in ten rated their health status as “very good” or “excellent” (37.7%). Respondents’ demographic characteristics were similar to the general population on many characteristics (Supplement A-1).

Table 1.

Characteristics of the sample (N = 1120).

Characteristics	%	n
Age
18-25	14.8	166
26-34	18.3	205
35-44	18.6	208
45-54	17.0	190
55-65	16.4	184
65+	14.9	167
Sex
Male	47.9	536
Female	52.0	582
Other	0.2	2
Education
Less than high school graduate	4.1	46
High school graduate	32.1	360
Some college of 2-year degree	30.0	336
College graduate	24.3	272
Graduate school	9.5	106
Race/Ethnicity
White (non-Hispanic)	68.2	764
Asian	6.1	68
Black	12.6	141
Latino	11.2	125
Other	2.0	22
Income
Less than $30K	33.8	378
$30,000-$74,999	42.1	471
$75,000-$124,999	15.9	178
$125,000 or higher	9.2	92
Insurance status
Employer-based	33.4	373
Self	12.4	138
Medicare	23.7	265
Medicaid	17.7	198
None	10.1	113
Other	2.7	30
Health status
Poor/fair	26.3	294
Good	36.0	403
Very good/excellent	37.7	422
Party affiliation
Republican	32.2	360
Democrat	48.6	544
Neither	19.2	215
Rurality
Urban	30.2	324
Suburban	49.5	531
Rural	20.3	218
Region
Northeast	18.0	202
Midwest	21.9	245
West	20.3	227
South	39.8	446

Source: Authors’ analysis of anonymous, cross-sectional, online survey.

Nearly 85% of respondents reported that they had a regular health care provider (Table 2). In most cases (83.8%) that provider was a physician; 14.3% of respondents reported having another type of regular health care professional (e.g., nurse practitioner, physician assistant). Seventy-six percent of respondents “completely” or “mostly” trusted their regular doctor, regular health care provider, or doctors, in general (depending on the type of usual clinician or if they had one). Trust for each of these providers, separately, ranged from 65.4% (doctors, in general) to 82.7% (respondents' regular doctor).

Table 2.

Sources of regular care and degree of trust in providers (N = 1120).

Survey question	%	n
Do you have a person who you think of as your regular doctor or health care provider?
Yes	84.4	945
No	15.6	175
Is your regular provider a doctor or some other type of health care provider?^a
Doctor	83.8	791
Another type of health care provider (e.g., nurse practitioner, physician assistant)	14.3	135
Not sure	1.9	18
How much do you trust your regular doctor?^b
Not at all	0.5	4
Slightly trust	3.3	26
Moderately trust	13.5	107
Mostly trust	40.2	318
Completely trust	42.5	336
How much do you trust your regular health care provider?^c
Not at all	1.5	2
Slightly trust	3.7	5
Moderately trust	20.0	27
Mostly trust	39.3	53
Completely trust	35.6	48
In general, how much do you trust doctors?
Not at all	2.5	28
Slightly trust	7.6	85
Moderately trust	24.5	274
Mostly trust	47.9	535
Completely trust	17.5	196
In general, how much do you trust hospitals?
Not at all	4.1	46
Slightly trust	14.7	165
Moderately trust	29.9	335
Mostly trust	39.6	444
Completely trust	11.6	130
How much do you trust your regular doctor/regular health care provider/doctors, in general?
Not at all to moderate	24.1	265
Mostly	39.2	431
Completely	36.8	405

Source: Authors’ analysis of anonymous, cross-sectional, online survey.

^aThis question was asked only of those who reported that they had a person who they thought of as their regular doctor or health care provider (n = 945).

^bThis question was asked only of those who reported that their regular provider was a doctor (n = 791).

^cThis question was asked only of those who reported that their regular provider was some other type of health care provider (e.g., nurse practitioner, physician assistant) (n = 135).

Respondents’ reported strong support for cannabis (Table 3)—73.0% reported that it should be legal in the U.S. More than one-half of respondents reported ever using cannabis (58.5%), and, while a plurality of prior users reported no past-month use (46.3%), 21.4% reported heavy use—that is using cannabis 21-30 days in the past month. Nearly equal proportions of past-month cannabis users indicated that they used for medical (30.1%), recreational (37.8%), or both reasons (32.1%). Table 3 includes other use pattern information including the route of administration.

Table 3.

Respondents’ cannabis use and willingness to use medical cannabis, if recommended (N = 1120).

Survey question	%	n
Do you think medical marijuana should be legal in the United State?
Yes	73.0	817
No	14.6	163
Not sure	12.5	140
Have you ever used marijuana in any form?
Yes	58.5	655
No	39.2	439
Not sure	2.3	26
During the past 30 days, on how many days did you use marijuana?^a
None	46.3	303
1-4 days	16.6	109
5-10 days	8.9	58
11-20 days	6.9	45
21-30 days	21.4	140
During the past 30 days, which one of the following ways did you use marijuana the most often?^b
Smoke it (e.g., joint, bong, pipe, blunt)	67.3	237
Eat it (e.g., brownies, gummies, candy)	15.1	53
Drink it (e.g., tea, cola, alcohol)	2.3	8
Vaporize it (e.g., e-cigarette-like vaporizer)	7.4	26
Dab it (e.g., using waxes or concentrates)	6.8	24
Some other way	1.1	4
When you used marijuana in the past 30 days, was it usually for medical reasons, recreational reasons, or both?^b
Medical reasons (like to treat or reduce symptoms of a health condition)	30.1	106
Recreational (like to have fun, get high, or socialize)	37.8	133
Both	32.1	113
If your regular doctor suggested that you use medical marijuana to treat a disease or decrease symptoms of a health condition, would you consider using it?^c
Definitely or probably not	22.5	123
Maybe	25.6	140
Probably	24.5	134
Definitely	27.6	151
If your regular health care provider suggested that you use medical marijuana to treat a disease or decrease symptoms of a health condition, would you consider using it?^d
Definitely or probably not	20.4	22
Maybe	25.0	27
Probably	27.8	30
Definitely	26.9	29
If a doctor suggested that you use medical marijuana to treat a disease or decrease symptoms of a health condition, would you consider using it?^e
Definitely or probably not	25.2	28
Maybe	30.6	34
Probably	22.5	25
Definitely	21.6	24
If you were in a hospital and medical marijuana was recommended to treat your health condition, would you be willing to use it?^f
Definitely or probably not	19.4	149
Maybe	25.2	193
Probably	26.5	203
Definitely	28.9	222
If your regular doctor, regular health care provider, or a doctor suggested that you use medical marijuana to treat a disease or decrease symptoms of a health condition, would you consider using it?^f
Definitely or probably not	22.6	173
Maybe	26.2	201
Probably	24.6	189
Definitely	26.6	204

Source: Authors’ analysis of anonymous, cross-sectional, online survey.

^aThis question was asked only of those who reported that they had ever used marijuana (n=655).

^bThis question was asked only of those who reported that they had past-month used marijuana (n=352).

^cThis question was asked only of those who reported that their regular provider was a doctor and that they did not use marijuana in the last 30 days (n=548).

^dThis question was asked only of those who reported that their regular provider was not a doctor (i.e., was another type of health care provider or did not know) and that they did not use marijuana in the last 30 days (n=108).

^eThis question was asked only of those who reported that they did not have a regular provider and that they did not use marijuana in the last 30 days (n=111).

^fThis question was asked only of those who reported that they did not use marijuana in the last 30 days (n=768).

We asked the 768 respondents who were not past-month users whether they would be willing to consider using medical cannabis if it were recommended by their regular doctor, regular health care provider, or a doctor (depending on the type of usual clinician or if they had one). Across these subgroups, more than one-half (51.2%) reported a “definite” or “probable” willingness to consider its use (Table 3). Respondents’ willingness to consider using the drug ranged from 44.1% if recommended by a doctor to 54.7% if recommended by their regular health care provider. During a hospitalization, 55.4% of respondent reported a “definite” or “probable” willingness to consider using the drug, if recommended.

Generally, the greater respondents’ trust in their clinician, the more likely they were to report a willingness to consider using recommended medical cannabis (Table 4). Among those who had lower trust in their clinician (“not at all,” “slightly trust,” or “moderately trust”), 20.6% reported “definitely” being willing to consider using the drug if recommended; this compares to 42.5% who “completely” trusted their provider and were “definitely” willing to consider using recommended medical cannabis. The relationship between these variables was statistically significant (chi-square = 27.6; P < .001).

Table 4.

Relationship between level of trust and willingness to consider using recommended medical cannabis (N = 767).

Type of Trust	If your regular doctor/regular provider/a doctor suggested that you use medical marijuana to treat a disease or decrease symptoms of a health condition, would you consider using it?
Trust in clinicians (i.e., usual doctor/usual provider/a doctor)	Probably/Definitely not	Maybe	Probably	Definitely
Not at all to moderate	22.4% (61)	31.3% (85)	25.7% (70)	20.6% (56)
Mostly	24.2% (89)	23.1% (85)	27.2% (100)	25.5% (94)
Completely	18.1% (23)	24.4% (31)	15.0% (19)	42.5% (54)
Chi-square 27.6 P < .001
Type of trust	If you were in a hospital and medical marijuana was recommended to treat your health condition, would you be willing to use it?
Trust in hospitals, in general	Probably/Definitely not	Maybe	Probably	Definitely
Not at all to moderate	20.6% (74)	26.7% (96)	27.0% (97)	25.6% (92)
Mostly	19.4% (63)	23.8 (77)	28.4% (92)	28.4% (92)
Completely	14.3% (12)	23.8% (20)	16.7% (14)	45.2% (38)
Chi-square 14.7 P = .023

Source: Authors’ analysis of anonymous, cross-sectional, online survey.

A similar pattern was seen in our examination of participants’ trust in hospitals and their willingness to consider using recommended medical cannabis (Table 4). Among those who had lower trust in hospitals (“not at all,” “slightly trust,” or “moderately trust”), 25.6% reported “definitely” being willing to consider using recommended medical cannabis. A higher proportion of respondents who “completely” trusted hospitals (45.2%) were “definitely” willing to consider using the drug, if recommended. The relationship between these variables was also statistically significant (chi-square = 14.7; P = .023).

Results from our supplemental analyses were consistent with these findings—that is, the greater respondents’ trust in their clinicians or hospitals, the more likely they were to report a willingness to consider using recommended medical cannabis.

Discussion

Cannabis has been found to have a variety of therapeutic uses. In its review, the National Academy of Medicine found conclusive or substantial evidence of cannabis’ effectiveness in treating chronic pain in adults, as antiemetics in the treatment of chemotherapy induced nausea and vomiting; and for improving patient-reported multiple sclerosis spasticity symptoms¹²; yet, some patients are reluctant to try medical cannabis because of its federal prohibition or stigma. This could potentially limit the drugs' therapeutic benefits and patients’ positive outcomes.

Our study highlights the importance of the patient-provider relationship in patients’ willingness to use medical cannabis if recommended by a trusted provider. As our findings demonstrate, when respondents trust their provider—clinician or hospital—they are more likely to consider using medical cannabis, if recommended. This is consistent with the existing literature that finds patients who trust their clinician are more willing to follow through with clinicians’ recommendations,^9,21,22 but this is the first examination, to our knowledge, that has tested the relationship between trust and a medical treatment that is illegal at the federal-level and has stigma.

Our findings are useful in a variety of contexts. First, providers who certify patients for medical cannabis or recommend medical cannabis as a treatment should be aware that trust matters. Individual clinicians, and the organizations in which they work, should avail themselves of the strategies that are known to build and increase trust among patients—for example, emphasizing interpersonal relationships built on empathy and listening,^23-25 promoting patient choice and activation, establishing policies around transparency, and measuring and reporting trust alongside other performance metrics.^26-28

Second, given stigma’s role in underuse of medical cannabis,^13,29 efforts should be made to normalize use of the drug. Incorporating content about medical cannabis into health professions’ licensure and education requirements, teaching providers how to comfortably discuss medical cannabis with patients, and integrating questions about medical cannabis use into standardized patient records systems could contribute to this effort. Efforts by policymakers to reduce or remove criminal sanctions for cannabis would contribute to easing societal perceptions of cannabis’ illicit status.

Findings from our study should be placed in the context of the limitations of our data and methods. Specifically, we surveyed a sample of adults whose characteristics mirror the U.S. adult population (Supplement A-1)—although our sample underrepresented Latinos and those with less than high school educations—but were not representative or generalizable Supplement A-1. Ever-use of cannabis was reported to be higher in our sample (58.5%) than in nationally representative surveys (50%)³⁰ although the proportions of those who reported using cannabis for medical (30.1% vs 28.6%), recreational (37.8% vs 38.2%), or both (32.1% vs 33.1%) reasons were similar to other national surveys.³¹ Additional research should be conducted to explore the trust-medical cannabis relationship among a diverse, nationally representative sample.

Conclusion

Trust is an essential component of the therapeutic relationship. Prior studies have found an association between patient-provider trust and a variety of positive health behaviors and outcomes. In a large sample of U.S. adults, we found strong, persistent relationships between provider trust and respondents’ willingness to use recommended medical cannabis. Respondents who expressed greater trust in their clinicians and hospitals were more willing to use recommended medical cannabis. These findings underscore the importance of patient-provider trust, particularly as more states legalize cannabis for medical use and as cannabis’ therapeutic benefits are recognized.

Supplemental Material

Supplemental Material - Are Patients Who Trust Their Providers More Likely to Use Medical Cannabis?

Supplemental material for Are Patients Who Trust Their Providers More Likely to Use Medical Cannabis? by Ellen T. Kurtzman and Jessica Greene in American Journal of Hospice and Palliative MedicineÂ®

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Ellen T. Kurtzman

Supplemental Material

Supplemental material for this article is available online.

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Supplementary Material

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