Palliative & supportive care
August 1, 2023
Xuepeng Jing, Nicholas R Hoeh, David B Menkes
18 citations
A scoping review of pipeline clinical trials identified 25 studies of psychedelic treatment for depression, anxiety, and existential distress at end of life, including 13 randomized controlled trials and 12 open-label trials. Investigational drugs included ketamine (11 trials), psilocybin (10), MDMA (2), and LSD (2); three trials involved microdosing, and fifteen incorporated psychotherapy. Only three trials assessed expectancy and blinding effectiveness beyond randomization. The review expects ongoing trials to extend evidence for psychedelic-assisted group therapy and microdosing, but head-to-head comparisons of different psychedelics and more rigorous studies controlling expectancy are still needed.
Palliative & supportive care
April 22, 2025
Maria I Lapid, Sandeep R Pagali, Andrea L Randall et al.
9 citations
A systematic review of 14 studies (three randomized controlled trials, five open-label trials, five qualitative studies, and one case report) found that psilocybin-assisted therapy consistently reduced depression, anxiety, and existential distress in patients with life-threatening cancer. Improvements lasted several months. Adverse effects were generally mild and temporary. The review concludes that psilocybin therapy shows potential as an effective treatment for cancer-related psychological distress, but larger, well-designed trials are needed to confirm the findings.
Palliative & supportive care
December 1, 2023
Roxanne Sholevar, John Peteet, Justin Sanders et al.
9 citations
Experts in serious illness care and psychedelic-assisted therapy (PAT) hold divergent views on PAT's therapeutic potential and safety for patients with serious illness. Five factors shape their attitudes: perception of unmet need, knowledge of empirical studies, personal psychedelic experience, professional background, and age or generation. An overarching theme is PAT's disruptive potential at four levels: the patient's experience of self, illness, and death; relationships with loved ones and healthcare providers; existing clinical models; and societal attitudes toward death. Whether this disruption is seen as a therapeutic opportunity or an undue risk determines the level of support. These points of disruption raise practical and philosophical considerations for integrating PAT into serious illness care.
Palliative & supportive care
January 27, 2025
Chrystabel Butler, Natasha Michael, David Kissane
6 citations
Spiritual care is critical to palliative care, yet comprehensive interventions are lacking, especially for the growing number of people in Western secular societies who identify as 'no religion' or 'spiritual but not religious.' A hermeneutic narrative review, inspired by complexity theory, found that a fundamental spiritual need in postmodern post-Christian secularism is for embodied spiritual experience, which has been lost alongside the historical decline of ritual. Ritual, as a mind-body practice, can provide such experience. Ritual originates from evolutionarily adaptive behaviors that develop emotional regulation and conceptual cognition, and its mechanisms allow connection to others and the transcendent. Understanding these mechanisms enables anyone to create personally meaningful rituals as self-empowering, client-centered spiritual care without relying on experts or institutional programs.
Palliative & supportive care
January 21, 2025
Caroline Dorsen, Lola Noero, Michelle Knapp et al.
5 citations
Fifteen facilitators of naturalistic psychedelic groups in the United States described community as essential to every aspect of psychedelic work: from motivation to use psychedelics, through the dosing experience, to integrating lessons into daily life. Thematic analysis identified two overarching themes: the arc of healing through community (with subthemes of intention, the group journey experience, and integration) and naturally occurring psychedelic communities as group therapy (with subthemes of belonging, authenticity, corrective experience, trust, and touch). The findings suggest that existing knowledge about therapeutic group processes may help structure and optimize group psychedelic work. More research is needed on group size, composition, substance selection, facilitator training, and community integration. Psychedelic groups may provide benefits that individual work does not.
Palliative & supportive care
October 1, 2024
4 citations
Palliative care professionals see psilocybin-assisted therapy as a promising treatment for existential distress in patients with serious illnesses, but they have several concerns. In a qualitative study using World Café methodology with 16 palliative care professionals, participants identified needs for educational and certified training, medical legalization of psilocybin, more research, refined therapy protocols, and clarity on who dispenses the therapy, where it is given, and eligibility criteria. The acceptability of the therapy and expanding access appear interrelated, and developing guidelines will be essential for wider deployment.
Palliative & supportive care
October 1, 2024
Carolina Simões, Miguel Julião, Patrícia Calaveiras et al.
1 citation
A 70-year-old man with stage IV renal carcinoma and bone metastasis experienced neuropathic pain, depression, and a persistent desire for death. Continuous subcutaneous infusion of morphine 30 mg and ketamine, increased to 250 mg/day over 28 days, led to overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological distress. Minor psychological side effects were controlled with midazolam in the infusion. The case highlights the benefit of the subcutaneous route for ketamine therapy in palliative patients cared for at home, an alternative to intravenous or oral formulas used in hospice care.
Palliative & supportive care
January 21, 2025
Amvrine Ganguly, Monique James, Yesne Alici
Physician-assisted dying (PAD) includes both euthanasia and medical aid in dying (MAiD). Euthanasia is illegal in the United States, while MAiD is legal in some jurisdictions. This paper reviews a case in which a patient successfully carried out a MAiD request, with the consultation-liaison psychiatry department involved at various stages of care. The case highlights end-of-life care issues, debates, and treatment modalities for individuals requesting MAiD. The authors suggest MAiD will remain a sensitive and controversial topic and that clinicians should engage in the debate to facilitate informed decision making.