Psychedelic-Assisted Interventions in Palliative Care: A Narrative Overview and Critical Evaluation.

Background/Objectives: Patients in palliative care frequently experience multidimensional suffering that extends beyond physical symptoms to include existential distress, demoralization, and loss of meaning. Psychedelic-assisted therapies (PAT), including ketamine-assisted psychotherapy (KAP), have re-emerged as promising interventions for these domains. This study aimed to provide a narrative overview and critical evaluation of the existing secondary literature on PAT in palliative care and serious illness and to examine the extent to which emerging best-practice recommendations are reflected in this literature.

Methods: An overview of reviews with framework-based narrative synthesis was conducted, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses addressing psychedelic-assisted interventions in patients with life-limiting illness. A comprehensive search of major databases was performed from inception to February 2026. Data extraction and narrative synthesis focused on clinical outcomes, safety, and the incorporation of key domains derived from recent interdisciplinary best-practice recommendations for PAT in palliative care.

Results: Twenty-two reviews were included, synthesizing evidence primarily from early-phase clinical trials and observational studies, predominantly in oncology populations. Across reviews, PAT was consistently associated with reductions in depression, anxiety, and existential distress, along with improvements in quality of life and spiritual well-being. Safety profiles were generally favorable under controlled conditions. However, the incorporation of key therapeutic domains—such as preparation and integration, therapeutic setting, clinician training, and relational and biographical factors—was heterogeneous and often incomplete. Most reviews emphasized outcomes over process and context.

Conclusions: The current body of secondary literature suggests potential application of PAT to address psychological and existential suffering in palliative care. However, the available evidence remains preliminary and is predominantly derived from small early-phase studies characterized by methodological heterogeneity, limited blinding, and highly selected populations. At the same time, the partial incorporation of emerging best-practice recommendations highlights a gap between evidence synthesis and normative clinical guidance.