Guided by the TPB and a strong sample size, this study gained an understanding of the motivations of Canadian cancer survivors who made the decision to medicate or not medicate their cancer symptoms with cannabis. Overall, study participants generally reported favorable attitudes toward medicating their cancer symptoms, such as pain and insomnia, with cannabis; this finding has been reported elsewhere. ¹⁶ Despite these perceived benefits, not all participants made the decision to manage their cancer‐related health needs with cannabis.

The cancer survivors in the study were affected differently by their behavioral, normative, and control beliefs regarding medicating with cannabis. The importance of the constructs in predicting behavior appeared to be impacted by the level of experience the individual has had with cannabis. nMWCs wanted more information to address their concerns about unwanted side‐effects and potential interactions with medications they are currently taking. Conversely, MWCs typically required no additional information because they already had strong perceptions of the benefits of cannabis, which included reduction of burden related to polypharmacy; this finding has also been reported elsewhere. ¹⁶ Cost was a concern for some MWCs but due to their experience, they were aware of the availability of options to purchase cannabis; this, in turn, provided them with a sense of control over how much they spent on cannabis.

The legalization of nonmedical cannabis in Canada played a role for some participants in their decision‐making process. Legalization provided them with a sense of social acceptance and legitimacy for them to medicate with cannabis. This was reflected in their discussions of wanting to portray a desirable image of themselves, as well as to others. Furthermore, legalization led them to feel that the quality control of cannabis had improved compared to products prior to legalization (i.e., consumed products have accurate labeling and do not contain molds or pesticides ¹⁶ ). For individuals who had previously been medicating with cannabis long term, legalization had no impact. These individuals still preferred to obtain their cannabis from their private and unregulated sources at lower costs.

The normative beliefs held by individuals appear to have the greatest impact on whether they made the decision to medicate their cancer symptoms with cannabis. It was apparent that many participants desired the approval of important individuals in their lives, especially their medical team, when making this decision. A mixed level of physician comfort discussing cannabis was observed. Some participants reported that their physicians were willing to facilitate access to cannabis by writing a prescription or providing a referral to a medical cannabis expert. Moreover, some participants reported frustration and dissatisfaction with their physicians’ lack of willingness to discuss cannabis as an option for managing their cancer symptoms; this potentially could have led some participants to be misinformed about medicating with cannabis (i.e., cannabis curing cancer). ¹⁹ However, some participants reported medicating with cannabis, despite not getting recommendations from their physicians, as their behavioral and control beliefs were stronger than their normative beliefs.

Physicians’ willingness to recommend cannabis to their patients may be dependent upon the policies set in place by their respective medical regulatory authorities (i.e., professional colleges). Many Colleges prohibit or strongly discourage dispensing, providing, or accepting delivery of cannabis for medical purposes, which likely impacts physicians’ willingness to recommend cannabis for their patients. In addition, a recent study reported that oncology health‐care providers felt that they lacked the knowledge to recommend cannabis to their patients because they desired the ability to monitor their patients’ cannabis use and to prescribe accurate doses ¹¹ ; as a result, physicians did not feel ready, and did not want to, answer patients’ questions about medical cannabis. ²⁰ , ²¹

To the best of our knowledge, this is the first study that applied the TPB to understand the impact of national legalization of cannabis on cancer survivors’ decision to medicate or not medicate with cannabis using qualitative methodology. While Victorson et al. explored attitudes of American cancer survivors regarding medical cannabis for their symptom management using focus groups, ⁵ results from the United States (US) are difficult to interpret, as state‐level legalization legislation remains in conflict with federal law. ²² Thus, the legal status of cannabis remains ambiguous, and patients’ attitudes in the United States will be influenced by this ambiguity. That said, several of our findings were similar to those reported by Victorson et al. Similar findings included benefits for symptom management and side‐effect relief, concerns regarding the social stigma with the image of using cannabis among their social circles, cost of cannabis, and worry about the legal consequences were raised; though for our study, the last point is now alleviated with the Canadian legalization of nonmedical cannabis. While the burden related to polypharmacy was not raised, Victorson et al. found that their study sample believed that cannabis was a safer alternative to many conventional medications that they were prescribed.

Individuals with a range of tumor sites participated in the study; the most prevalent were colorectal and breast cancers, which aligned with the most recent Canadian cancer statistics. ²³ Lung and prostate cancers were the other most prevalent cancers in Canada but individuals diagnosed with lung and prostate cancers were under‐represented in our study. Using social media to recruit study participants allowed us to gain a wide range of perspectives from cancer survivors in Canada. The participants, however, were primarily recruited from Ontario and BC, the two most populous provinces. While social media broadened the recruitment coverage, we may have missed perspectives from individuals who do not have Internet access or do not follow social media. Given the online nature of our recruitment strategy, we relied on convenience sampling, which may lead to noncoverage bias in that the decision to participate in the study is at the discretion of the individuals and we do not have means of knowing about those who do not participate. ²⁴ As all interviews were conducted in English, we may have missed out on important viewpoints of non‐English speaking cancer survivors. We were able to gain nearly equal perspectives of MWCs and nMWCs to ensure that conversations were not highly in favor of medicating cancer symptoms with cannabis. In addition, our analysis highlighted the complexities that were faced by nMWC participants, who were considering cannabis for their cancer symptoms.

This study has shown that individuals affected by cancer positively perceived cannabis to alleviate symptoms such as pain, neuropathy, and insomnia. Our data revealed that, despite this favorable attitude toward cannabis, not everyone made the decision to medicate with cannabis. Individuals’ behavioral, normative, and control beliefs regarding medicating with cannabis provided vital information on what motivated their uptake of cannabis. An investigation of the underlying beliefs regarding medicating with cannabis can provide information on what motivates this behavior and may offer important future research avenues, including optimizing follow‐up cancer care. This information is important to health‐care providers in cancer as they receive the professional training and formal education required to support and educate cancer patients and survivors to improve self‐care, knowledge, and overall empowerment.