Exploring the Use of Psilocybin Therapy for Existential Distress: A Qualitative Study of Palliative Care Provider Perceptions

Introduction

Psilocybin is a naturally occurring psychedelic compound that has been used historically for healing and spiritual purposes. Recent clinical research and regulatory developments—such as FDA "breakthrough therapy" designations and state-level changes in legal status—have prompted renewed interest in psilocybin as a therapeutic tool. Within palliative care, existential distress is common among patients with life-limiting illness, is difficult to treat, and can worsen pain, depression, anxiety, demoralisation, feelings of being a burden, and requests for hastened death. Emerging clinical studies suggest that controlled psilocybin therapy (PT)—which typically includes careful screening, preparatory work, supervised dosing with trained guides, and integration sessions—may produce rapid and sustained reductions in existential distress and improvements in meaning, quality of life, and interpersonal relationships. Mayer and colleagues set out to explore a gap in the literature: the perspectives of interdisciplinary palliative care providers about existential distress and the possible use of psilocybin therapy in this population. The study aimed to characterise providers' experiences managing existential concerns, identify barriers to addressing those needs, and document beliefs, attitudes, and uncertainties regarding PT as a potential treatment option should legal and regulatory conditions change. Understanding provider perceptions was framed as important for planning safe, inclusive, and feasible pathways for PT integration into palliative care if it becomes legally accessible.