{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:57:43Z","timestamp":1789707463699,"version":"4.0.1"},"reference-count":21,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cannabis &amp; Cannabinoid Research"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:p>This article introduces a framework of contextual effectiveness to reconcile the persistent gap between patients\u2019 positive experiences with treatments and negative clinical trial outcomes in palliative care. Using medicinal cannabis as an illustrative example, we challenge the statistical assumption that averaging patient responses yields a reliable \u201ctrue effect\u201d for subjective outcomes like quality of life. We argue that treatment effects vary not only between patients but also within the same patient across contexts and time. While averaging approaches remain valid for discrete symptoms (e.g., pain), a patient\u2019s reported improvement in overall well-being in specific situations may reflect genuine contextual effectiveness rather than placebo or misattribution. Highly individualized findings complicate guideline and funding decisions; hence, we propose a dual-pathway model for evidence generation: traditional randomised controlled trials (RCTs) for population-level efficacy, followed by post-trial contextual surveillance studies (CSS) that empower individualized patient-clinician decisions. This framework maintains scientific rigor while enabling more person-centered care. By recognizing that a patient may be both a \u201cresponder\u201d and \u201cnon-responder\u201d depending on life context, we offer a paradigm shift in how subjective outcomes are understood, evaluated, and applied in palliative care practice.<\/jats:p>","DOI":"10.1177\/25785125261417394","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T06:51:01Z","timestamp":1768805461000},"page":"198-204","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Limits of Averages: A Framework for Contextual Effectiveness in Palliative Care Medicinal Cannabis Research"],"prefix":"10.1177","volume":"11","author":[{"given":"Taylan","family":"Gurgenci","sequence":"first","affiliation":[{"name":"Mater Misericordiae Ltd., Brisbane, Australia."},{"name":"Mater Research Institute, University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Olson","sequence":"additional","affiliation":[{"name":"School of Social Science, University of Queensland, St Lucia, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Smith","sequence":"additional","affiliation":[{"name":"School of Social Science, University of Queensland, St Lucia, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Stokes","sequence":"additional","affiliation":[{"name":"Mater Misericordiae Ltd., Brisbane, Australia."},{"name":"Mater Research Institute, University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip D.","family":"Good","sequence":"additional","affiliation":[{"name":"Mater Misericordiae Ltd., Brisbane, Australia."},{"name":"Mater Research Institute, University of Queensland, Brisbane, Australia."},{"name":"St Vincent\u2019s Private Hospital Brisbane, Kangaroo Point, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,18]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06691-1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-02160-z"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01632"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-025-09763-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13642"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.11.031"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.7497\/j.issn.2095-3941.2015.0041"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2022-006690"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.10.370"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/0195078640.001.0001"},{"key":"e_1_3_3_12_2","first-page":"105","volume-title":"Handbook of qualitative research","author":"Guba EG","year":"1994","unstructured":"Guba EG, , Lincoln YS. Competing paradigms in qualitative research. In: Handbook of qualitative research. Sage Publications, Inc.: Thousand Oaks, CA; 1994; pp. 105\u2013117."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781506335193.n6"},{"key":"e_1_3_3_14_2","volume-title":"Illness: the cry of the flesh","author":"Carel H","year":"2013","unstructured":"Carel H. Illness: the cry of the flesh. Acumen: Durham; 2013."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.10.004"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-024-08091-z"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2024.0422"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1215\/9780822384151"},{"key":"e_1_3_3_19_2","volume-title":"Philosophical foundations of neuroscience","author":"Bennett MR","year":"2003","unstructured":"Bennett MR, , Hacker PMS. Philosophical foundations of neuroscience. 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