Journal of Palliative Medicine
January 22, 2018
Ira Byock
164 citations
Despite growing evidence that psychedelics are safe and beneficial, political, regulatory, and industry hurdles block their legitimate medical use. Federal expanded access programs and state right-to-try laws already allow terminally ill patients to receive unapproved medications. Because many such patients endure persistent suffering and physician-hastened death is increasingly accepted, the authors argue it is time to reconsider the legitimate therapeutic use of psychedelics.
Journal of Palliative Medicine
August 1, 2022
William E Rosa, Zachary Sager, Megan Miller et al.
49 citations
Psychedelic-assisted therapy (PAT) is a promising treatment for conditions like treatment-resistant depression, substance use disorder, and PTSD. In palliative care, a single PAT session can produce lasting reductions in anxiety, depression, and demoralization—symptoms that harm quality of life for seriously ill and end-of-life patients. Although interest in psychedelics has revived, few resources exist for applying PAT in hospice and palliative care. This article provides 10 evidence-informed tips for palliative care clinicians, developed with international experts, to help familiarize teams with PAT, address legal and logistical barriers, discuss therapeutic competencies, and highlight approaches to maximize safety and benefits for patients and caregivers.
Journal of Palliative Medicine
April 1, 2020
Yvan Beaussant, Justin J. Sanders, Zachary Sager et al.
39 citations
Experts in serious illness care and psychedelic research hold polarized views on psychedelic-assisted therapies for patients with serious illness, ranging from strong support for medical utility to reluctance due to risks such as delirium or worsening psychological distress. Research priorities focus on patients with clinically diagnosed psychosocial distress like depression, anxiety, or demoralization, though some roles extend beyond traditional medical diagnosis. Essential safety and efficacy guidelines are needed for integrating these therapies into existing care models. The study proposes a conceptual framework for such integration based on interviews with 17 experts from the United States and Canada.
Journal of Palliative Medicine
January 22, 2025
Roxanne Sholevar, William Kromka, Yvan Beaussant
10 citations
In patients with serious medical illness, ketamine may produce rapid but temporary improvements in psychiatric symptoms such as depression and anxiety, according to a review of nine studies and twelve case reports. The evidence is limited by wide variation in patient groups, treatment settings, dosing, and whether psychotherapy was included. Most reports examined ketamine as a drug alone, not ketamine-assisted psychotherapy (KAP). There is little research on KAP for existential distress, though the findings hint that ketamine used within a psychedelic therapy model could offer advantages over traditional psychedelics. Current treatments for psychiatric and existential distress in palliative care are often ineffective or poorly tolerated.
Journal of Palliative Medicine
August 17, 2023
Robert Gramling, Emily Bennett, Keith Curtis et al.
6 citations
Directly observing therapeutic connection during psilocybin-assisted therapy is feasible. In a clinical trial, three coders independently reviewed audio and video from four 8-hour psilocybin administration sessions, identifying 372 moments of therapeutic connection. Eighty-three percent of these moments were detected by at least two coders, and 41% by all three. Coders used both audible cues (speech prosody, words) and visible cues (body movements, eye gaze, touch) in 51% of observed events. The expressions of connection varied as the drug's effects on consciousness changed over time. The findings suggest that evaluating both sound and video is necessary to capture the full range of therapeutic connection.
Journal of Palliative Medicine
October 1, 2023
Noah D Gold, Austin J. Mallard, Jacob C Hermann et al.
5 citations
Psychedelic-assisted psychotherapy (PAP) may help alleviate psychiatric and existential distress in people with amyotrophic lateral sclerosis (ALS), a terminal neurodegenerative disease with an average survival of 3-4 years. The authors suggest PAP could also intervene on neuropathological dimensions of ALS, based on neuroprotective properties of psychedelics and robust improvements seen in other populations. They call for future preclinical trials in ALS models and rigorous clinical trials, given the lack of effective treatments for both disease progression and psychological distress.
Journal of Palliative Medicine
January 1, 2025
Mercy Tomy, William B Alexander, Sanjay Gupta et al.
4 citations
Three patients with cancer, treatment-resistant depression, and suicidal ideation received intranasal esketamine (Spravato®) at a palliative care clinic. After treatment, all three had substantial reductions in depression severity and no further suicidal ideation, with improvements lasting up to a year. No serious adverse events occurred. The cases suggest intranasal esketamine may be a useful option for treating depression and suicidal thoughts in palliative care.
Journal of Palliative Medicine
September 12, 2024
Jean-François Stephan, Sani Karam
2 citations
A patient with end-of-life distress from stage 4 astrocytoma received psilocybin-assisted therapy through a special access program and had a positive response without adverse events. Standard treatments for existential distress are often ineffective, and psilocybin-assisted therapy is rarely available, especially for patients with brain cancer. The authors argue that access to this therapy needs to be expanded urgently, as many patients with unresolved existential distress resort to medical assistance in dying without knowing about psilocybin-assisted therapy.
Journal of Palliative Medicine
June 1, 2025
Sam Barta, Joanne Brooker, Clare O'Callaghan
1 citation
Health care workers hold polarized views on psychedelic-assisted therapy for patients with serious illness, with attitudes often shaped by limited research knowledge and heuristics. Most perceive potential benefits for treating refractory psychological distress, desire education about the therapy, and call for a stronger evidence base to support implementation. Barriers to integration into existing care models were identified, and a team-based approach with clinical education was seen as essential. The systematic review of nine studies (seven qualitative, two quantitative) from four countries developed five themes reflecting these findings.
Journal of Palliative Medicine
June 25, 2024
Mary P. Clark
1 citation
No Summary
Journal of Palliative Medicine
July 15, 2020
Anthony L. Back
1 citation
No Summary
Journal of Palliative Medicine
November 9, 2018
Anthony L. Back
1 citation
No Summary
Journal of Palliative Medicine
March 1, 2026
Robert K Horowitz, William E Rosa, Ali John Zarrabi et al.
Psychospiritual distress causes profound suffering in people with serious illness, yet treatment options are few. A palliative care-embedded ketamine-assisted psychotherapy (KAP) program called Pal-KAP was developed and delivered at an academic medical center. Between May 2023 and September 2025, 59 patients were referred for screening; 43 met eligibility criteria, and 30 elected to participate. Patients (age 19-76, mean 53) completed a median of 1.5 medicine sessions (range 1-5). Most had cancer (80%) or neurological disease (13.3%). Ketamine dose averaged 0.93 mg/kg intramuscularly, with minor adverse effects and no serious adverse events. This experience suggests that KAP can be delivered safely and ethically in palliative care.
Journal of Palliative Medicine
April 26, 2025
Alyssa A Gonzalez, Gladys Janice Jimenez-Torres, Bryan M Fellman et al.
A five-minute group meditation offered during weekly educational rounds was well-received by palliative care clinicians. Of 70 invited, 23 (59%) participated in the meditation during rounds, and 21 (54%) also meditated at least weekly outside of rounds, averaging 53 minutes per week, mostly after work hours. Participation was linked to perceived stress reduction and control, and satisfaction with meditation (odds ratio: 1.46). No significant differences in participation were found by gender or years worked. Clinicians in psychosocial roles did not show different engagement outside rounds, and those less engaged did not report greater time-related barriers. The findings suggest brief group meditation may be a feasible and helpful tool for clinician well-being.
Journal of Palliative Medicine
June 24, 2026
Muhammad Hamza Habib, Laura Fontanesi, Zainab Yusufali Motiwala et al.
Clinicians frequently encounter end-of-life dreams and visions (ELDVs) in patients with serious or terminal illness, but they feel underprepared to respond. A survey of 247 health care professionals found that participants perceived positive effects of ELDVs on patients more often than negative effects. The most commonly reported clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than other challenges. Participants endorsed multidisciplinary involvement and formal policy implementation. There is a need for structured training and institutional protocols to address ELDVs in clinical care.
Journal of Palliative Medicine
November 1, 2025
Kathryn Levy, Gina Schuster, Sheila Conboy et al.
End-of-life dreams and visions (ELDVs) are common and meaningful for people nearing death, but this study found no difference in self-transcendence between hospice patients who experienced ELDVs and those who did not. Seventy-two hospice patients (35 with ELDVs and 37 without) completed the Self-Transcendence Scale. No significant differences emerged between groups (p = 0.310). Patients with ELDVs did not report greater self-transcendence than nondreaming patients, and no individual survey items differed. The authors suggest self-transcendence may be a natural developmental stage, closely tied to religiosity and end of life, or that holistic hospice care itself may influence self-transcendence, obscuring any effect of ELDVs.
Journal of Palliative Medicine
April 30, 2024
Min Ji Kim, H. Walker, Matthew D Clark et al.
A postoperative cancer patient who was taking buprenorphine–naloxone for chronic noncancer pain and then switched to methadone for uncontrolled cancer-related pain successfully transitioned back to buprenorphine–naloxone using a microdosing strategy over one week in an inpatient setting. This approach avoided the need to reduce total opioid intake before starting buprenorphine, which is typically required to prevent precipitated withdrawal. The case suggests that microdosing may be a feasible method for transitioning from methadone to buprenorphine in patients who require higher opioid doses, such as those with cancer pain, though more research on its tolerability is needed.
Journal of Palliative Medicine
December 20, 2021
Kyle Quirk, Maximillian H. Stevenson
Microdosing induction of buprenorphine, in which the drug is gradually titrated while full agonist opioids are continued, offers a viable alternative to traditional inductions that require an opioid-free interval or withdrawal. This review of 34 publications found that the most common strategy involved administering divided doses of sublingual products marketed for opioid use disorder, with 73.5% of articles using partial tablets or films ranging from 1/8 to 1/2 of a 2 mg product. Transdermal patches, low-dose sublingual buprenorphine available in Europe, intravenous buprenorphine, and buccal buprenorphine have also been used. The speed of induction, setting, final dosing, and management of concomitant full agonists varied widely.
Journal of Palliative Medicine
October 1, 2005
Anna-Leila Williams, Peter A Selwyn, Lauren Liberti et al.
A combination of meditation and massage improved overall and spiritual quality of life more than either intervention alone or standard care among people with late-stage AIDS. Fifty-eight residents of an AIDS-dedicated nursing facility were randomly assigned to one month of meditation, massage, both, or standard care. The combined group showed significantly greater improvement in overall and transcendent (spiritual) quality-of-life scores at eight weeks compared with the other groups. The results suggest that pairing a meditation practice with physical touch may address both spiritual and physical needs near end of life.