Developing a Shared Vision 1Unsatisfactory 0-710.00.docx

Developing a Shared Vision
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80.0 %Content
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100 %Total Weightage
Medical Marijuana In Cancer Treatment 6
Medical Marijuana in Cancer Treatment
Samantha Howard

Grand Canyon University: NRS-490 (NRS-490-O503)
Running Head: Medical Marijuana In Cancer Treatment 1
January 27, 2019
Medical marijuana is an herbal medicine derived from dried
leaves and buds from the cannabis sativa plant and has been
used as a precaution for centuries. It is used to relieve
symptoms of several chronic diseases such as pain caused from
cancer among others. The herb is readily available on the
market since legalization in 1996 and is acceptable for use in
thirty-one states as of November, 2018 (Hawkes, N. 2018).
According to the US Drug Enforcement Administration (DEA),
the FDA has not yet approved marijuana as a safe and effective
drug for any chronic illness but is aware that there is substantial
interest in the use to attempt to treat several medical conditions,
including cancer (FDA, 2018).
The setting or context in which medical marijuana can be used
During the last five years, the use of medical marijuana for
alleviation of cancer pain has become significantly popular at
the state levels. Marijuana laws are set in place to monitor daily
dispense dose, proper follow-up, check and balance system have
been maintained to assure that the doses will only be issued for
treatment of recognizable chronic disease. (Ananth, P., Reed-
Weston, A., & Wolfe, J. 2017). The use of medical marijuana is
more acceptable, as several specialists are now prescribing for
alleviation of unbearable pain and vomiting during
chemotherapy and radiation, after getting approval from the
chairman and directors of the hospital therapeutics committee
(Lankenau, et al., 2018).
According to MacCallum, C. A., & Russo, E. B. 2018 evidence-
based practices are limited, regarding the biological effects on

patient and there is a need to conduct more studies with a larger
sample size, so that the evidence are clear on its effect on
chronic illness such as in alleviation of cancer pain
(MacCallum, C. A., & Russo, E. B).
Possible harms of marijuana and educational need.
Although Marijuana is effective for the alleviation of pain when
used for treating cancer patients, it has certain chemicals that
are harmful to the body. One of the most common side effects is
the feeling of euphoria, this is because the herb contain is a
mixture of several natural herbs and compounds that causes
various side effects the body. It depresses the user control over
his or her movements, causes negative thoughts and
disorientation, increase appetite, anxiety and places the user at
risk for depression (Pacher, P., et al., 2018). Due to this, patient
should be educated on all aspect of the herb as it is difficult for
doctors to predict how it affects the patient. Patients should be
informed that the usage of cannabinoids can lead myocardial
infarction, cardiomyopathy, and strokes (Pacher, P., et al.,
2018). It also causes high delta-9-tetrahydrocannabinol (THC)
or marijuana high in users (Hawkes, N. 2018).
Significance of the problem and its implications to nursing
According to a study, the use of medical marijuana interacts
with both prescribed and over counter drugs with a negative
correlation especially between prescribed drugs (Caputi, T. L.,
& Humphreys, K. 2018). This can result from misuse of
cannabis, as users are unlikely to use as prescribed especially
for pain reliefs regardless of health professional teaching and
can lead to increase recreational use (Pacher, P., et al., 2018).
Proposed
Solution

In the past, marijuana was considered illegal due to its non-
medical use. Presently thirty-one states, have adapted its
practice medically, as studies shows when used in for the
alleviation of pain such as in cancer there is positive outcome
(Todd, T., 2018). To prevent misuse precautionary measures
have been implemented by Medicare, such as laws that reduce
the daily dose of the medicine issued to medical departments for
analgesics use, to help prevent accessibility for recreational use
(Powell, D., Pacula, R. L., & Jacobson, M. 2018.

References
1. Lankenau, S. E., Ataiants, J., Mohanty, S., Schrager, S.,
Iverson, E., & Wong, C. F. (2018). Health conditions and
motivations for marijuana use among young adult medical
marijuana patients and non‐patient marijuana users. Drug and
alcohol review, 37(2), 237-246.
2. Pacher, P., Steffens, S., Haskó, G., Schindler, T. H., &
Kunos, G. (2018). Cardiovascular effects of marijuana and
synthetic cannabinoids: the good, the bad, and the ugly. Nature
Reviews Cardiology, 15(3), 151.
3. Caputi, T. L., & Humphreys, K. (2018). Medical marijuana
users are more likely to use prescription drugs medically and
non-medically. Journal of addiction medicine, 12(4), 295-299.
4. Hawkes, N. (2018). Cannabis-based drugs: how will they be
used in practice?
5. Todd, T. (2018). The Benefits of Marijuana Legalization and
Regulation. Berkeley Journal of Criminal Law, 23(1), 6.
6. Powell, D., Pacula, R. L., & Jacobson, M. (2018). Do medical
marijuana laws reduce addictions and deaths related to pain

killers? Journal of health economics, 58, 29-42.
7. Ananth, P., Reed-Weston, A., & Wolfe, J. (2017). Medical
marijuana in pediatric oncology: A review of the evidence and
implications for practice. Pediatric Blood & Cancer, 65(2),
e26826.doi:10.1002/pbc.26826
8. MacCallum, C. A., & Russo, E. B. (2018). Practical
considerations in medical cannabis administration and
dosing. European journal of internal medicine, 49, 12-19.
9. FDA and Marijuana, 2018. Retrieved from
https://www.fda.gov/NewsEvents/PublicHealthFocus/ucm42116
3.htm
Literature Evaluation Table
Student Name: Samantha Howard
Change Topic (2-3 sentences):The implementation of medical
marijuana and non-medical marijuana in cancer patient for
alleviation of pain within one year of treatment

Criteria
Article 1
Article 2
Article 3
Article 4
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Vyas M.B, LeBaron V.T, Gilson A.M.
https://www.ncbi.nlm.nih.gov/pubmed/28993073
J Clin Oncol
J Clin Oncol
Zaki,Pearl., Blake,Alexia, Wolt, Amiti, Chan, Stephanie
https://www.researchgate.net/publication/324088950_The_Use_
of_medical_cannabis_in_cancer_patients
Article Title and Year Published
The use of cannabis in response to the opioid crisis: A review of
the literature. 2018
Medical Oncologists' Beliefs, Practices, and Knowledge

Regarding Marijuana Used Therapeutically: A Nationally
Representative Survey Study. 2018
Medical Marijuana Use in a Community Cancer Center. 2018
The use of medical cannabis in cancer patients. 2017
Research Questions (Qualitative)/Hypothesis (Quantitative), and
Purposes/Aim of Study
The purpose of the article is to examine state medical cannabis
(MC) use laws and policies and their potential association with
POM use and related harms.
To determine whether oncologists reported discussing MM with
patients, recommended MM clinically in the past year, or felt
sufficiently informed to make such recommendations.
Compare the incidence of marijuana use between patients with
early- versus advanced-stage cancers. Examine differences in
adverse effects, drug-drug interactions, and drug-disease
interactions between those who use marijuana and those who do
not.
To examine the efficacy of cannabis treatment among cancer
patients to manage symptoms from a single Canadian medical
cannabis provider
Design (Type of Quantitative, or Type of Qualitative)
Quantitative: Exploratory study
A systematic literature review was conducted to explore United
States policies related to MC use and the association with POM

use and related harms. Medline, PubMed, CINAHL, and
Cochrane databases were searched to identify peer-reviewed
articles published between 2010 and 2017
Quantitative Study
Bivariate and multivariate analyses were performed using
standard statistical techniques.
Quantitative Study
The overall incidence of marijuana use was 18.3% (32 of 175
patients). The incidence of marijuana uses in patients with
early- versus advanced-stage cancers was 19.6% (11 of 56
patients) versus 17.6% (21 of 119 patients; P = .75).
Quantitative Study
164 patients reported a current or previous diagnosis of cancer,
of which the most common types
of primary tumors were gastrointestinal (17.7%, n = 29),
breast (13.4%, n = 22), leukemia and lymphoma (13.4%, n =
22), gynecologic (9.2%, n = 15), prostate (7.3%, n = 12), and
lung (7.3%, n = 12).
Setting/Sample
A systematic literature review 11,513 records were identified,
with 789 abstracts reviewed, and then 134 full-text articles
screened for eligibility via Medline, PubMed, CINAHL, and

Cochrane databases to identify peer-reviewed articles published
between 2010 and 2017.
A survey on random sample of 400 medical oncologists.
Electronic self-reported questionnaire completed by patients age
18 years and older who were receiving chemotherapy.
164 cancer patients
Methods: Intervention/Instruments
A systematic literature review on EBP peer- article to support
the use of MM verse opioid use
Randomize survey on oncologist.
Questionnaire
Online survey of 2573 patients, use of Pain Self-Efficacy
Questionnaire
Analysis
A systematic literature review was conducted to explore the use
of cannabis in response to the opioid crisis:
Analysis of responses of oncologist on the use of MM in pain in
patient
Analysis of data indicating the implications of cannabis
treatment on cancer patients.
Analysis of data collected from survey from periods of between
4 to 10 months from initial use of cannabis by cancer patients
Key Findings

Of 134 articles, 10 articles met inclusion criteria. The literature
suggests MC laws could be associated with decreased POM use,
fewer POM-related hospitalizations, lower rates of opioid
overdose, and reduced national health care expenditures related
to POM overdose and misuse.
Overall response 63%. 30% of oncologists felt sufficiently
informed to make recommendations, 80% discussions with
patients, 46% recommended for clinical use. 67% viewed it as a
helpful adjunct to standard pain management strategies, and
65% thought MM is equally or more effective than standard
treatments for anorexia and cachexia
The overall incidence of marijuana use was 18.3% (32 of 175
patients). early- versus advanced-stage cancers was 19.6% (11
of 56 patients) versus 17.6% (21 of 119 patients; P = .75)
164 patients indicated current or prior cancer diagnosis and 56.3
percent previously used cannabis for symptom relief while 73.6
percent reported current use
Recommendations
Review of the current literature suggests states that implement
MC policies could reduce POM-associated mortality, improve
pain management, and significantly reduce health care costs
More research is needed regarding critical gaps in research,
medical education, and policy regarding MM.
The risks versus benefits should be discussed with all patients

who use marijuana.
Need for more studies to establish the efficacy of medical
cannabis as compared to first line therapies among cancer
patients
Explanation of How the Article Supports EBP/Capstone Project
Having knowledge that MM use reduces the number of
overdoses seen with other pain management suppose the cause
for the use of cannabis in cancer patient for pain relief.
This article provided EBP date that provided oncologist
thoughts on the use of MM patient dealing with cancer
This article provided information that was relevant towards my
EBP as it relates to drug interactions, benefits and limitation of
MM
This article provided information on the outcome of a year
along use of cannabis used among cancer patients
Criteria
Article 5
Article 6
Article 7
Article 8
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article

Abrams, D.I.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791148/
Johnson JR; Lossignol D; Burnell-Nugent M; Fallon MT
https://reference.medscape.com/medline/abstract/23141881
Jessica. C, Paul. J, D
http://ascopubs.org/doi/10.1200/jco.2015.33.29_suppl.198
Alexia B, Bo A, W, Leila. M, C, DeAngelis, Patrick D, Nicholas
L, Edward C, O’Hearn. S
http://apm.amegroups.com/article/view/16199/18209
Article Title and Year Published
Integrating cannabis into clinical cancer care, 2016
An open-label extension study to investigate the long-term
safety and tolerability of THC/CBD oro-mucosal spray and oro-
mucosal THC spray in patients with terminal cancer-related pain
refractory to strong opioid analgesics. 2013
Use of medical cannabis to reduce pain and improve quality of
life in cancer patients. 2017
A selective review of medical cannabis in cancer pain
management. 2017

Research Questions (Qualitative)/Hypothesis (Quantitative), and
Purposes/Aim of Study
The purpose of the article is show Integrating cannabis into
clinical cancer care
The purpose of the study was investigated the long-term safety
and tolerability of THC/CBD spray and THC spray in relieving
pain in patients with advanced cancer.
The purpose of the study is to determine if the addition of
cannabinoids (medical cannabis) resulted in the reduction of the
average opioid dose required for pain control and improve self-
reported quality of life indices.
To evaluate the efficacy of cannabinoid-based therapies
containing tetrahydrocannabinol (THC) and cannabidiol (CBD)
for reducing cancer-associated pain
Design (Type of Quantitative, or Type of Qualitative)
Qualitative study
Exploratory study
Quantitative Study
A review of literature: Quantitative Study
A variety of doses ranging from 2.7–43.2 mg/day THC and 0–40
mg/day CBD were administered. Higher doses of THC were
correlated with increased pain relief in some studies. One study
found that significant pain relief was achieved in doses as low
as 2.7–10.8 mg THC in combination with 2.5–10.0 mg CBD, but
there was conflicting evidence on whether higher doses provide

superior pain relief.
Setting/Sample
28 studies of 2454 participants
43 patients with cancer-related pain
(n = 24). Patient 18 and older
Five studies that evaluated THC oil capsules, THC: CBD
oromucosal spray (nabiximols), or THC oromucosal sprays
found some evidence of cancer pain reduction associated with
these therapies.
Methods: Intervention/Instruments
Study of randomized clinical trials of participants
Randomized controlled trial of 43 patients
A retrospective chart review of cancer patients followed in our
CCMB Pain and Symptom Clinic was conducted.
Small pilot studies conducted in 1975, to double-blind placebo-
controlled trials conducted in 2014
Analysis
Analysis of data indicating the implications of cannabis
treatment on cancer patients in several clinical trials
Analysis of data available to support use of cannabis for cancer
treatment
Review of cancer patients followed in our CCMB Pain and

Symptom Clinic was conducted
Reviews the history of marijuana for relief and therapy
treatment of cancer patients
Key Findings
Cannabis has certain benefits particularly handling symptoms,
and direct anticancer effects of cannabinoids
No new safety concerns associated with the extended use of
THC/CBD spray arose from this study. This study showed that
the long-term use of THC/CBD spray was generally well
tolerated, with no evidence of a loss of effect for the relief of
cancer-related pain with long-term use
Patients with cancer pain benefited from the addition of
cannabinoids
Significant pain relief was achieved in doses as low as 2.7–10.8
mg THC in combination with 2.5–10.0 mg CBD, but there was
conflicting evidence on whether higher doses provide superior
pain relief
Recommendations
Need for more human studies to manage current effects
The outcome of the study was met.
Further prospective controlled studies are needed to further
elucidate the role of cannabinoids in the treatment of cancer
pain.

There is a need for the conduct of further double-blind, placebo-
controlled clinical trials with large sample sizes to establish the
optimal dosage and efficacy of different cannabis-based
therapies.
Explanation of How the Article Supports EBP/Capstone
Discusses studies available indicating outcome of use of
cannabis in cancer management that can be used to support my
capstone project.
Provides expert opinion on use of medical marijuana in cancer
management
This article provided EBP data on the outcome for patient who
used MM for pain treatment
The article provided studies available indicating outcome of use
of cannabis in cancer management in 1975 and 2014. Give an
insight as to how long MM has been studied
© 2015. Grand Canyon University. All Rights Reserved.
© 2017. Grand Canyon University. All Rights Reserved.
Running head: MEDICAL MARIJUANA IN CANCER
TREATMENT 1

MEDICAL MARIJUANA IN CANCER TREATMENT6
Medical Marijuana in Cancer Treatment
Samantha Howard
February 20, 2019
PICOT: The implementation of medical marijuana and non-
medical marijuana in cancer patient for the alleviation of pain
within one year of beginning treatment
Cannabis has been relied on for medical purses in many parts of
the world. Many states have begun implementing the medical
and recreational cannabis policies and this is leading to the rise
in the number of individuals using the cannabis, for example,
marijuana for the reduction of pain especially among the cancer
patients. There is the existence of the theoretical reasons for the
efficacy of marijuana for the management of the pain (Hill,

Palastro, Johnson, & Ditre, 2017). This PICOT discussion,
therefore, aims at looking at some literature work by comparing
their questions, the sample used, limitations ad with some
conclusions as well as recommendation to discuss about "the
implementation of medical marijuana and non-medical
marijuana in cancer patient for the alleviation of pain within
one year of beginning treatment."
Comparison of the research questions
The article Vyas et al. on the utilization of the cannabis during
the opioid crisis aimed at examining the state medical cannabis
(MC) use laws as well as the policies and their possible link
with the POM use and the associated injuries (Vyas, LeBaron, &
Gilson, 2018). Journal of the clinical oncology, on the other
hand, was aimed at determining whether oncologists described
having discussed medical marijuana with the patients; whether
they made a recommendation on medical marijuana clinically
for the past year or whether they felt adequately getting
information to come up with such approvals (Braun, et al.,
2018). The third article whose title is Medical marijuana use in
a community cancer center aimed at comparing the cases of the
marijuana use amongst patients who are having an early versus
advanced stage cancer impacts, drug to drug interactions, and
the drug-disease interactions between individuals using
marijuana with those who are not using it (Saadeh & Rustem,
2018).

The fourth article by Zaki et al. aimed at examining the efficacy
of cannabis treatment amongst cancer patients for the
management of the symptoms from a single Canadian medical
cannabis provider (Zaki, et al., 2017). Article by Abram
targeted at showing integrating cannabis into the clinical cancer
care while that of Johnson et al. aimed at performing the
investigation on the long-term safety as well as the tolerability
of the THC or the (cannabidiol) CBD spray and
tetrahydrocannabinol (THC) spray to help in pain relieving for
the patient suffering from advanced cancer (Johnson, Lossignol,
Burnell-Nugent, & Fallon, 2013). Jessica et al. and Alexia et al.
on the other hand aimed to determine whether the addition of
cannabinoids leads to the decrease in the average opioid dose
needed for the control of pain and improvement of the
individual reported life quality; and to evaluate the
effectiveness of the cannabinoid-based treatment containing
THC and CBD for the reduction of the cancer-associated pain
respectively.
Comparison of the sample population
The work by Vyas et al. was based on the use of 11, 513, 789,
134 literature reviews, abstract reviews, and full-text articles
respectively. On the other hand, the second article of the
Journal of Oncology utilized a survey random study on a sample
of 400 medical oncologists. There is no specification on the
number of samples used in the third article whereas work by

Zaki et al. utilized 164 cancer patients for the study. The study
by Abram was based on the use of 28 studies which consisted of
2454 participants (Abrams, 2016). A study by Johnson et al.
used a total of 43 patients suffering from cancer-related pain. A
total of 24 patients of ages 18 years old were used as samples in
the study by Jessica whereas a study by Alexia was based on the
use of five studies which assessed THC oil capsules, THC, CBD
oromucosal spray (Alexia, et al., 2017).
Comparison of the study limitations
The restriction of the study by Abrams is that few human
studies related to the management of the medical cannabis
impacts were used. A study by Jessica et al. failed to fully
utilized prospective control studies to help in the elucidation on
the role of the CBD in treating cancer pain. A study by Alexia
et al. used a few numbers of samples for the establishment of
the optimal dosage as well as the efficacy of various cannabis-
based treatments. A study by Vyas et al. was majorly based on
looking at the past studies and this means that some information
provided could be out-of-date. In the second article i.e. J Clin
Oncol, there is a concern related to the inconsistency between
the oncologists'self-reported acquaintance base and their
opinions as well as practices with regard to Medical Marijuana.
A specific number of the participants used for the study in the
third article were never specified thus raising concern in
relation to the authenticity of the study.

Conclusions
Based on the evidence presented by the literature studies, it is
clear that medical marijuana is helpful in the reduction of the
pain among cancer patients. Therefore, it is important for the
starts to take into consider medical advancement and implement
policies to help in the reduction of the POM associated deaths,
improving the management of pain, and the healthcare costs. In
order to reduce major health concerns about the use of medical
marijuana, it is important to perform further research to help
with the understanding of medical marijuana. The research
should also be aimed at looking at the aspects related to the
risks and benefits associated with the use of medical marijuana
on cancer patients. This can be achieved by performing more
prospective control studies to help in elucidating the role of the
CBD.
References
Abrams, D. I. (2016). Integrating cannabis into clinical cancer
care. Cyrre Oncol, 23(2), S18-S14.
Alexia, B., Bo, A. W., Leila, M., Carlo, D.-A., Diaz, P., Lao,
N., et al. (2017). A selective review of medical cannabis in
cancer pain management. Annals of Palliative Medicine, 6(2).
Braun, I. M., Wright, A., Peteet, J., Meyer, F. L., Yuppa, D. P.,
Bolci-Jankovic, D., et al. (2018). Medical Oncologists' Beliefs,
Practices, and Knowledge Regarding Marijuana Used

Therapeutically: A Nationally Representative Survey Study.
Journal of Clinical Oncology, 36(19), 1957-1962.
Hill, P. K., Palastro, D. M., Johnson, B., & Ditre, W. J. (2017).
Cannabis and Pain: A Clinical Review. Cannabis and
Cannabinoid Research, 2(1), 96-104.
Johnson, J. R., Lossignol, D., Burnell-Nugent, M., & Fallon, M.
T. (2013). An open-label extension study to investigate the
long-term safety and tolerability of THC/CBD oromucosal spray
and oromucosal THC spray in patients with terminal cancer-
related pain refractory to strong opioid analgesics. Journal of
Pain Symptom Manage, 46(2), 207-218.
Saadeh, C. E., & Rustem, D. R. (2018). Medical Marijuana Use
in a Community Cancer Center. Journal Oncol Pract, 14(9),
e566-e578.
Vyas, M. B., LeBaron, V. T., & Gilson, A. M. (2018). The use
of cannabis in response to the opioid crisis: A review of the
literature. Nurs Outlook, 66(1), 56-65.
Zaki, P., Alexia, B., Amiti, W., Henry, L., Carlo, D., Marissa,
S., et al. (2017). The use of medical cannabis in cancer patients.
Journal of Pain Management, 10(4), 353-362.
3
MEDICAL MARIJUANA USE IN CANCER PATIENT

The implementation of medical marijuana and non-medical
marijuana in cancer patient for the alleviation of pain within
one year of beginning treatment.
Samantha Howard
Running head: ASSIGNMENT TITLE HERE
1
Running head: MEDICAL MARIJUANA USE IN CANCER
PATIENT
February 2, 2019
PICOT: The implementation of medical marijuana and non-
within one year of beginning treatment.
In the United States today, the use of medical marijuana for
treatment has increase among several states with an increase
interest in outpatient palliative care to integrate medical
cannabis into their symptom management (Spencer, N, Shaw, E,
Slaven, M. 2016) Evidence-based research studies are

conducted to prove the correlation between marijuana and
cancer pain and several studies are proven effective.
Clinical problem and Evidence-based solution
The use of medical marijuana is a much debatable topic for
decade, and in since recent years interest has grown
significantly (Kramer, J. L. 2015). As of November 2018, 31
stated are now participating in prescribing yet, it is still
considered a schedule I substance. Studies on medical
marijuana focuses on treatment for the alleviation of pain due
cancer among other symptoms (Kramer, J. L. 2015). This is
because it has lower side effects than non-medical marijuana
users. Also, screening for psychiatric and substance use
disorders is warranted with the authorization of medical
marijuana (Wall M. M, Liu. J, Hasin. D, S, Blanco C, Olfson.
M, 2019).
Nursing Intervention, Population and Patient Care
As nurses we have a moral duty to advocate for patient
autonomy and preferred choices. Education and support are
needed to provide the best care for patient without bias
regarding cannabis use. Nursing intervention should be geared
towards educating patient who meets the criteria for use of
medical marijuana, by reviewing the benefits, risks, safety
concerns, side effects and potential hazards with specialist It is
also important for nurses to be current with the new evidence
base practice that are being conducted on the efficacy of

medication marijuana when dealing with patient who are
terminally ill due to cancer and suffer from pain (Green, A. J.,
& De‐Vries, K. 2010).
Health Care Agency
Long-term care agencies that provide care to patient in their
home or hospice, deal with patients who suffer from cancer and
complained of pain daily. Currently the use of medical
marijuana has been legalized in the state of New York and
participating specialist have been prescribing to cancer patient
for the alleviation of pain, allowing them to live a pain free life
as much as possible (Lucas, P., Baron, E. P., & Jikomes, N.
2019)
Nursing Practice
Cannabis nursing specialty has increased tremendously and
require a clear understanding in the area in which it is being
used. On July 14, 2017 the American Cannabis Nurses
Association (ACNA) released version 1.0 of the standards of
Practice and the scope for cannabis nurses. Nurses must be
conscious that cannabis and most cannabinoids are federally
illegal and recognize their state’s outline for the scope of
nursing practice along with their facility policies.
(cannabisnurses, 2017).
Marijuana Vs Non-Marijuana use such as Opioids Comparison
Dealing with cancer pain can be difficult for the patient, their
family and even the healthcare providers. Non-marijuana

methods such as opioids can be devastating as it can lead to
addiction and overdose. There is an increase in death in patient
using non-marijuana methods such as seen with the use of
prescription opioids. Due to this several states have
implemented polices to help to reduce the number of overdoses
by using alternate therapies for pain management, such as
medical marijuana (Vyas, M. B., LeBaron, V. T., & Gilson, A.
M. 2018).
Outcomes of Picot Statement
Several evidence base researches conducted over a course of
five years provided substantial information on the use of
has proven to be effective and safer when compared to non-
marijuana treatment such as opioid that can lead to addiction
and overdose (Vyas, M. B., LeBaron, V. T., & Gilson, A. M.
2018

References
Kramer, J. L. (2015). Medical marijuana for cancer. CA: a
cancer journal for clinicians, 65(2), 109-122
Vyas, M. B., LeBaron, V. T., & Gilson, A. M. (2018). The use
of cannabis in response to the opioid crisis: A review of the
literature. Nursing Outlook, 66(1), 56-65.
Lucas, P., Baron, E. P., & Jikomes, N. (2019). Medical cannabis
patterns of use and substitution for opioids & other
pharmaceutical drugs, alcohol, tobacco, and illicit substances;
results from a cross-sectional survey of authorized patients.
Harm Reduction Journal, 16(1), 9.
Green, A. J., & De-Vries, K. (2010). Cannabis use in palliative
care–an examination of the evidence and the implications for
nurses. Journal of clinical nursing, 19(17‐18), 2454-2462.
Spencer, Noah, Shaw, E, Slaven, Marissa. (2016). Medical
cannabis uses in an outpatient palliative care clinic: A
retrospective chart review. Nursing & Allied Health Database,

Vol. 9, Iss. 4, (2016): 507-513.
American Cannabis Nurses Association, 2017. Scope &
Standards of Practice for Cannabis Nurses. Retrieved from
https://cannabisnurses.org/Scope-of-Practice-for-Cannabis-
Nurses
Wall M. M, Liu. J, Hasin. D, S, Blanco C, Olfson. M, 2019.
Benchmark - Capstone Project Change Proposal
1
Unsatisfactory 0-71%
0.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%

60.0 %Content
5.0 %Background
Background section is not present.
Background section is present, but incomplete or otherwise
lacking in required detail.
Background section is present. Some minor details or elements
are missing but the omission(s) do not impede understanding.
Background section is present and complete. The submission
provides the basic information required.
Background section is present, complete, and incorporates
additional relevant details and critical thinking to engage the
reader.
5.0 %Problem Statement
Problem statement is not present.
Problem statement is present, but incomplete or otherwise
Problem statement is present. Some minor details or elements
Problem statement is present and complete. The submission
Problem statement is present, complete, and incorporates
reader.

5.0 %Change Proposal Purpose
Purpose of change proposal is not present.
Purpose of change proposal is present, but incomplete or
otherwise lacking in required detail.
Purpose of change proposal is present. Some minor details or
elements are missing but the omission(s) do not impede
understanding.
Purpose of change proposal is present and complete. The
submission provides the basic information required.
Purpose of change proposal is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.
5.0 %PICOT
PICOT is not present.
PICOT is present, but incomplete or otherwise lacking in
required detail.
PICOT is present. Some minor details or elements are missing
but the omission(s) do not impede understanding.
PICOT is present and complete. The submission provides the
basic information required.
PICOT is present, complete, and incorporates additional
relevant details and critical thinking to engage the reader.

5.0 %Literature Search Strategy
Literature search strategy is not present.
Literature search strategy is present, but incomplete or
Literature search strategy is present. Some minor details or
understanding.
Literature search strategy is present and complete. The
Literature search strategy is present, complete, and incorporates
reader.
5.0 %Literature Evaluation
Literature evaluation is not present.
Literature evaluation is present, but incomplete or otherwise
Literature evaluation is present. Some minor details or elements
Literature evaluation is present and complete. The submission
Literature evaluation is present, complete, and incorporates
reader.

5.0 %Utilization of Change or Nursing Theory (2.2)
Theory utilization is not present.
Theory utilization content is present, but incomplete or
Theory utilization content is present. Some minor details or
understanding.
Theory utilization content is present and complete. The
Theory utilization content is present, complete, and incorporates
reader.
5.0 %Proposed Implementation Plan with Outcome Measures
(3.2)
Implementation plan is not present.
Implementation plan is present, but incomplete or otherwise
Implementation plan is present. Some minor details or elements
Implementation plan is present and complete. The submission
Implementation plan is present, complete, and incorporates
reader.

5.0 %Identification of potential barriers to plan implementation,
and a discussion of how these could be overcome (2.3)
Identification of potential barriers to plan implementation and
/or discussion component is not present.
Identification of potential barriers to plan implementation with
a discussion component is present, but is incomplete or
a discussion component is present. Some minor details or
understanding.
a discussion component is present and complete. The
a discussion component is present, complete, and incorporates
reader.
5.0 %Appendices Inclusive of Practice Immersion Clinical
Documentation (1.2)
Appendices are not present.
Appendices are present, but incomplete or otherwise lacking in
required detail.

Appendices are present with minor elements missing that do not
impede understanding.
Appendices are present and complete. The submission provides
the basic information required.
Appendices are present, complete, and incorporates additional
relevant details and critical thinking to engage the reader.
10.0 %Evidence of Revision
Final paper does not demonstrate incorporation of feedback or
evidence of revision on research critiques.
Incorporation of research critique feedback or evidence of
revision is incomplete.
Incorporation of research critique feedback and evidence of
revision are present.
Evidence of incorporation of research critique feedback and
revision is clearly provided.
Evidence of incorporation of research critique feedback and
revision is comprehensive and thoroughly developed.
30.0 %Organization and Effectiveness
10.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis is insufficiently developed or vague. Purpose is not
clear.

Thesis is apparent and appropriate to purpose.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Thesis is comprehensive and contains the essence of the paper.
Thesis statement makes the purpose of the paper clear.
10.0 %Argument Logic and Construction
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.
Argument shows logical progression. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Clear and convincing argument presents a persuasive claim in a
distinctive and compelling manner. All sources are

authoritative.
10.0 %Mechanics of Writing (includes spelling, punctuation,
grammar, language use)
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.
Frequent and repetitive mechanical errors distract the reader.
Inconsistencies in language choice (register) or word choice are
present. Sentence structure is correct but not varied.
Some mechanical errors or typos are present, but they are not
overly distracting to the reader. Correct and varied sentence
structure and audience-appropriate language are employed.
Prose is largely free of mechanical errors, although a few may
be present. The writer uses a variety of effective sentence
structures and figures of speech.
Writer is clearly in command of standard, written, academic
English.
10.0 %Format
5.0 %Paper Format (use of appropriate style for the major and
assignment)
Template is not used appropriately, or documentation format is
rarely followed correctly.

Appropriate template is used, but some elements are missing or
mistaken. A lack of control with formatting is apparent.
Appropriate template is used. Formatting is correct, although
some minor errors may be present.
Appropriate template is fully used. There are virtually no errors
in formatting style.
All format elements are correct.
5.0 %Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to assignment and
style)
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous formatting
errors.
Sources are documented, as appropriate to assignment and style,
although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style,
and format is mostly correct.
Sources are completely and correctly documented, as
appropriate to assignment and style, and format is free of error.
100 %Total Weightage

Developing a Shared Vision 1Unsatisfactory 0-710.00.docx

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