Palliative & Supportive Care
November 3, 2022
Lisa Reynolds, Brian S. Barnett, Jeremy Weleff et al.
19 citations
Cancer health-care practitioners in New Zealand and the USA perceive psychedelic-assisted therapy as potentially beneficial for cancer patients, especially those with advanced disease no longer receiving curative treatment. They consider research in this area important and express willingness to refer patients to trials, though they emphasize that work should incorporate spiritual and indigenous perspectives of health. US practitioners had greater awareness of psychedelics, while New Zealand practitioners more strongly believed that spiritual and indigenous factors should be considered. The findings suggest that practitioners may be more open to studies beginning in palliative and end-of-life contexts.
Palliative & Supportive Care
August 1, 2023
Xuepeng Jing, Nicholas 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 J. 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
Marianne Masse-Grenier, Sue-Ling Chang, Ariane Bélanger et al.
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
January 1, 2026
Stephen P. Lewis
1 citation
Three patient-centered outcome measures for spiritual wellbeing—FACIT-Sp-12, EORTC QLQ-SWB-32, and NIH-HEALS—are suitable for use in psychedelic-assisted therapy with palliative care populations, based on a review of 286 articles. The NIH-HEALS is recommended for wider use because of its orientation toward identifying spiritual change in serious illness, strong reliability and validity, and accessibility across spiritual traditions.
Palliative & Supportive Care
January 1, 2025
Houman Farzin, Brigita Koren, Helen Ferrier et al.
1 citation
A 51-year-old man with metastatic lung cancer and a prognosis of less than 6 months experienced depression and anxiety linked to demoralization and existential distress, which persisted despite psychotherapy and 100 mg of sertraline. Through Health Canada’s Special Access Program, he received 25 mg of oral psilocybin in a homecare setting, with preparative and integrative therapy before and after the session. The treatment was well tolerated, and the patient reported a sustained reduction in suffering and improved well-being at 2 months post-intervention. Psilocybin-assisted therapy may be safely delivered at home and offer lasting relief for anxiety and depression associated with existential distress in palliative care.
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 1, 2026
Fiona Cottam, Alesha Wells, Cerys Clayden et al.
Participating in trials of psychedelic-assisted meaning-centered psychotherapy (MCP) may provide hope for both cancer patients and their caregivers. Because the well-being of patients and caregivers is interconnected, the authors argue that caregivers should be included alongside patients in these clinical trials.
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.
Palliative & Supportive Care
July 6, 2026
Megan F Noonan, Catherine E Mosher, Ekin Secinti et al.
The breath counting task (BCT), a computerized measure of present-moment awareness based on breath-counting accuracy, has shown validity as a behavioral measure of mindfulness in healthy populations but remained untested in clinical contexts. In a preliminary evaluation with 55 patient-caregiver dyads randomized to a 6-week mindfulness intervention or usual care, the BCT's validity differed for patients and caregivers. Among caregivers, breath-counting accuracy increased over time in the mindfulness condition and remained stable in usual care, indicating sensitivity to intervention. Among patients, greater accuracy was moderately associated with better quality of life at 1-month follow-up (r = .57), supporting criterion validity.
Palliative & Supportive Care
December 26, 2025
Taís Oliveira Silva, Bruno Angeli-Faez, Lorena Cândida Ferreira Paixão et al.
Near death, end-of-life dreams and visions (ELDVs) and delirium often overlap, making them hard to tell apart. This case report describes an elderly Brazilian woman with metastatic cancer who experienced both. ELDVs involved vivid encounters with deceased relatives and biographical themes, but many were distressing and occurred alongside fluctuating attention typical of delirium. The Confusion Assessment Method (CAM) identified delirium but could not distinguish ELDVs within delirious states. ELDVs often emerged during lucid windows with preserved recall and insight. Distress alone did not differentiate the two. Supplementing CAM with qualitative criteria—content, vividness, biographical meaning, insight, cultural fit, and recall—may prevent misclassification and support holistic palliative care.
Palliative & Supportive Care
March 8, 2021
Gil P. Soriano, Kathyrine A. Calong Calong
Among Filipino women recovering from breast cancer, higher spiritual well-being is linked to greater self-transcendence. The overall mean score for spiritual well-being was 4.41 out of a possible range, while self-transcendence averaged 3.64. A significant positive relationship between the two was found, indicating that spirituality helps these women find meaning in their illness. Assessing spirituality can help nurses provide more holistic care that supports coping with the challenges of the disease.
Palliative & Supportive Care
June 1, 2011
David K Wellisch, Marie Cohen
Cancer patients' poor sleep often involves both physical symptoms and nightmares. A review of about 30 articles and books, drawing on threat simulation theory and imagery rehearsal therapy, shows that nightmares in cancer patients reflect attempts to cope with threats like dependency, disfigurement, and death, especially in the doctor-patient relationship. Imagery rehearsal can help patients feel empowered rather than helpless. The review suggests that modern dream theories offer opportunities for interventions that relieve sleep disturbances and improve communication among patients, families, and medical caregivers.
Palliative & Supportive Care
December 1, 2009
Cynda Hylton Rushton, Deborah E Sellers, Karen S Heller et al.
A professional training program in contemplative end-of-life care, based on mindfulness and receptive attention, helped clinicians cultivate presence, balanced compassion, recognition of grief, and self-care. In a survey of 95 participants and interviews with 40, the program's contemplative practices were reported as meaningful and valuable, providing skills and attitudes that changed how clinicians worked with dying and bereaved people. The quality of presence was seen as potentially transforming care for dying people and caregivers, offering alternatives to purely intellectual and task-oriented approaches.