Psilocybin-assisted therapy for demoralisation in hospice patients: feasibility, safety and preliminary efficacy
Yvan Beaussant, Zachary Sager, Caitlin W. Brennan, Isabel Kristan, Michael Ljuslin, Emanuele Mazzola, David R. Macdonald, M. Murphy, Kabir Nigam, Alden Doerner Rinaldi, Justin J. Sanders, Kristen G. Schaefer, Roxanne Sholevar, Lisa Summer, Alifia Waliji-Banglawala, Sandra Yudilevich-Espinoza, James A. Tulsky
BMJ Supportive & Palliative Care November 3, 2025 DOI: 10.1136/spcare-2025-005773 via OpenAlex
Summary
AI-generated from the abstractA single 25 mg dose of psilocybin, combined with preparation and integration sessions, was safely administered to ten terminally ill home hospice patients. No serious adverse events occurred. Demoralization scores dropped by an average of 8.8 points three weeks after the session, despite patients' ongoing physical decline. Grief and peace themes were common during the drug sessions. Although most participants rated the treatment favorably, some found the emotional intensity challenging. The results suggest that psilocybin-assisted therapy can be feasibly and safely integrated into hospice care, but larger studies are needed to confirm its benefits.
Study at a glance
| Characteristics | Open-label pilot trial Pilot study Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Terminally ill patients receiving home hospice care |
| Intervention | Psilocybin-assisted therapy |
| Dose | 25 mg |
| Duration | Two home-based preparation sessions, a single psilocybin session, two home-based integration sessions; assessment at week 3 |
| Keywords | Terminally ill Medline Hospice care Patient safety Critically ill |
| Citations | 1 |
| Key finding | Psilocybin-assisted therapy was well tolerated and associated with a significant reduction in demoralization scores at week 3. |
Abstract
Objectives To assess the feasibility, safety and preliminary efficacy of psilocybin-assisted therapy (PAT) for demoralisation in terminally ill patients receiving home hospice care. Methods In this open-label pilot trial, 4607 home hospice patients at a large community hospice were screened over 22 months; 66 were approached, 15 enrolled and 10 received psilocybin. Participants completed two home-based preparation sessions, a single 25 mg oral psilocybin session at an inpatient hospice facility, and two home-based integration sessions. Feasibility was assessed through recruitment, retention and acceptability. Safety was evaluated via adverse event monitoring, and preliminary efficacy was assessed using changes in demoralisation scores and other psychosocial measures. Results The intervention was well tolerated, with no serious adverse events attributed to psilocybin. At week 3, demoralisation scores significantly decreased (mean reduction: 8.8 points, p=0.0196), despite ongoing clinical decline. Grief- and peace-related themes were prominent during psilocybin sessions. While six participants rated the treatment favourably on the Reaction to Research Participation Questionnaire global evaluation factor, three rated neutral on one or more items, suggesting that the emotional intensity and demands of the intervention may influence acceptability. Conclusion This study provides initial evidence that PAT can be feasibly and safely integrated into hospice care for terminally ill patients. Further research is needed to optimise delivery and further assess therapeutic potential.