Abstract
BackgroundExistential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored.MethodsThe present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content.ResultsNineteen respondents (seven physicians, four advanced practice nurses, four chaplains, three social workers, and one psychologist) were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain.ConclusionsPAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.
Highlights
Existential distress is a significant source of suffering for patients facing life-threatening illness
Existential distress, which overlaps with the concepts of existential suffering [1], spiritual distress [2], and demoralization [3], is distress that arises for patients in the
Psychedelic-assisted therapies (PAT), which apply psychotherapeutic approaches to altered states of consciousness produced by agents such as psilocybin, 3,4-Methylenedioxymethamphetamine (MDMA) or ketamine, may be potent treatments for patients facing existential distress in the setting of life-threatening illness (LTI)
Summary
Existential distress is a significant source of suffering for patients facing life-threatening illness. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored. Niles et al BMC Palliative Care (2021) 20:191 treatments for depressive symptoms are less effective in patients with LTI than in the general population [7] and targeted psychotherapeutic interventions demonstrate only modest benefit [8,9,10,11,12,13]. Psychedelic-assisted therapies (PAT), which apply psychotherapeutic approaches to altered states of consciousness produced by agents such as psilocybin, 3,4-Methylenedioxymethamphetamine (MDMA) or ketamine, may be potent treatments for patients facing existential distress in the setting of LTI. While the evidence base still awaits larger confirmatory trials, these encouraging phase 2 results have brought discussions of psychedelic medicine into mainstream circles [21, 22] and generated proponents within palliative care [23, 24]. Stigma around psychedelics persists [25] despite their benign safety profile compared to classified controlled substances [26, 27]
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