Health Care Workers’ Attitudes Toward and Knowledge of the Clinical Application of Classic Psychedelics for People with Serious Illness: A Systematic Review

Patients with serious, life-threatening illnesses frequently experience severe psychological and existential distress—depression, anxiety, death anxiety, demoralisation, and reduced quality of life—that existing pharmacological and psychological interventions often fail to relieve in the long term. Interest in classic psychedelics (for example, LSD and psilocybin) as adjuncts to psychotherapy has re-emerged after a decades-long research hiatus, with recent randomized trials reporting reductions in anxiety and depression and sustained benefits in some cancer cohorts. Psychedelic-assisted therapy (PAT), defined as the use of psychedelic medicines together with preparatory and integrative psychotherapy, is therefore being considered as a possible option for refractory distress in people with serious illness. Barta and colleagues set out to systematically synthesise the empirical literature on health care workers' (HCWs') attitudes and knowledge about the clinical application of classic psychedelics for patients with serious illness. The review aimed to integrate quantitative and qualitative studies to identify prevailing views, perceived barriers and facilitators to implementation, and implications for education, research, and clinical practice. The review was protocol-registered (PROSPERO CRD42023390329) and reported in line with PRISMA 2020 guidance.

The authors conducted a mixed-methods systematic review using the Joanna Briggs Institute (JBI) convergent integrated approach to bring together qualitative and quantitative evidence addressing the same question. Eligible studies were peer-reviewed empirical investigations (qualitative, quantitative or mixed methods), published in English from 2006 onwards, that examined HCWs' attitudes and/or knowledge about using classical psychedelics to treat psychological distress in patients with serious or life-threatening illness. Information sources included MEDLINE, CINAHL, and APA PsycInfo accessed via EBSCOhost, with an initial search on 23 December 2022 and an update on 12 May 2024. Forward and backward citation searching using Google Scholar and reference lists supplemented the database searches. Search terms combined concepts related to attitudes/knowledge, HCWs, and specific classical psychedelics (psilocybin, DMT, LSD); an information specialist assisted with strategy development. Study selection began with deduplication in EndNote and screening in Covidence. Two reviewers independently screened 1,952 titles and abstracts, discussed conflicts, and then each independently reviewed full texts; disagreements were resolved with a third reviewer. Ten articles representing nine studies met inclusion criteria. Data extracted included study aims, country, sample characteristics (HCW type, demographics), setting, recruitment, analysis method, and key findings; the extracted items were tabulated. Synthesis followed the JBI convergent integrated method: quantitative findings were "qualitised" (translated into textual descriptions) and integrated with qualitative data. Qualitative results sections were imported into Quirkos and analysed thematically using the Thomas and Harden approach (line-by-line coding to descriptive codes, then grouping into themes and subthemes). Two authors conducted extraction and quality appraisal, with checks by a third; two authors independently appraised methodological quality using the JBI checklists for cross-sectional and qualitative studies, scoring items as yes/no/unclear.

The search yielded nine studies (seven qualitative, two quantitative) published between 2014 and 2023 across four countries: the United States (seven studies, one involving Canada), New Zealand (one study solely in New Zealand), and the Czech Republic (one study). The quantitative studies together included 611 participants and the qualitative studies included 109 participants, as reported by the authors. Study characteristics and quality appraisals were presented in tabular form. Through synthesis, five major themes with nine subthemes were developed. First, HCWs held polarised views about PAT for patients with serious illness. Some considered PAT a novel, potentially transformative tool for refractory distress, emphasising mechanisms such as enhanced meaning, spiritual experiences, and altered attitudes to death; respondents who were supportive sometimes described PAT as an additional "tool in your toolbox." Others were curious but cautious, stressing the need to understand risk–benefit balances and to proceed in an evidence-based way. A subset were sceptical or unreceptive, citing existing efficacious treatments, the illicit status of psychedelics, and concerns that risks might outweigh benefits. Second, attitudes were frequently shaped by levels and sources of knowledge. Self-reported familiarity with PAT varied markedly: those aware of recent research were more open to PAT, while clinicians relying on heuristics (for example, media portrayals) were more likely to express negative beliefs such as risks of psychosis or addiction relapse. One survey finding referenced in the studies linked greater awareness with higher likelihood to view PAT as beneficial and to refer patients to trials. Third, participants commonly reported that a stronger evidence base was necessary to increase HCW confidence and support implementation. Requests included more randomized controlled trials, standardised outcome measures, clearer dosing and protocol guidance, contraindication data, and research on mechanisms and caregiver impact. HCWs distinguished between short-term drug effects and durable therapeutic change and wanted clarity on whether positive effects constituted lasting improvements in coping. Fourth, practical, social, and economic barriers to integration were emphasised. Practical concerns included the resource intensity of PAT (multihour dosing sessions, preparatory and integration therapy, involvement of multiple clinicians), potential interference with other clinical trials, regulatory and funding constraints, and access inequities if costs were not covered by health systems or insurers. Social stigma and community readiness were also cited as potential obstacles; some HCWs questioned public or patient acceptance. Suggestions for addressing resource barriers—drawn from included studies and discussed by participants—included investigating shorter-duration agents (for example, intravenous DMT) or group-based models to reduce supervision time and costs. Fifth, respondents emphasised the importance of a multidisciplinary, team-based approach and formal clinical education. HCWs suggested interdisciplinary teams including psychiatrists, psychotherapists, nurses, physicians, social workers, chaplains, and potentially new roles, with adequate therapist training and certification to support integration and mitigate harm. Several participants noted the value of integrating indigenous perspectives, and many expressed a desire for more education about safety profiles, contraindications, appropriate patient selection, and therapeutic roles. Quality appraisal findings were mixed: included studies typically had clear aims and suitable data collection methods, and quantitative studies handled confounding satisfactorily; however, methodological limitations were noted (for example, only one qualitative study reported congruent philosophical perspective and methodology). The authors also reported potential influences on participant candour, such as non-anonymous interviews and the illegal status of psychedelics in some jurisdictions.

Barta and colleagues interpreted the synthesis as evidence of wide variation in HCWs' receptiveness and knowledge about PAT for people with serious illness. Many HCWs recognised PAT's potential to alleviate refractory psychological and existential distress and supported further research, but there was no consensus on key implementation details such as eligibility criteria, contraindications, dosing, team composition, or risk mitigation strategies. The authors emphasised that expanding the evidence base—particularly randomized trials and standardised outcome measurement—was seen as necessary to address these uncertainties and to build HCW confidence. The findings were positioned relative to earlier reviews and surveys: similarities were noted in concerns about risks, implementation challenges, and knowledge limitations. The illicit legal status of psychedelics was repeatedly raised as a factor informing hesitancy, drawing parallels with clinician attitudes toward medicinal cannabis where stigma and drug labelling shape perceptions. Knowledge sources mattered: HCWs with greater self-reported knowledge or exposure to scientific presentations tended to be more supportive, while reliance on media-driven heuristics was associated with scepticism and beliefs about harms such as psychosis or addiction. Key implementation barriers acknowledged by the authors included the substantial clinician time and resource requirements of PAT (preparation, extended dosing sessions, integration), the potential cost and equity implications if public funding or insurance coverage is absent, and societal stigma. The review reported that some participants proposed practical adaptations—shorter-acting compounds (for example, intravenous DMT) or group therapy—as possible ways to reduce supervision time and costs. A majority of studies stressed the need for well-trained therapists and multidisciplinary teams; attributes for therapist training discussed in the literature included empathy, spiritual intelligence, self-awareness, ethical integrity, and knowledge of psychedelic effects. The authors reflected on the methodological quality and limitations of the included studies and of their review. Strengths of their work included a comprehensive search strategy across three databases, broad inclusion criteria, use of an established JBI mixed-methods approach, and involvement of multiple researchers in analysis. Limitations included restricting the review to English-language publications, underrepresentation of non-Western perspectives and traditional healers, limited reporting of participant demographics in some studies (notably sparse racial/ethnic diversity across six studies that reported these data), and the decontextualisation risk inherent in synthesising qualitative studies. The authors cautioned against overgeneralising findings across different cultural and health system contexts. Finally, implications identified by the authors include the need for targeted education for HCWs on PAT safety and indications, a stronger and larger clinical trial evidence base with dissemination across disciplines, inclusion of a wide range of HCWs (notably working palliative clinicians and music therapists) in future research, and exploration of attitudes among other stakeholders such as policymakers, patients, caregivers, and non-Western practitioners.

The review concluded that HCWs' attitudes toward PAT for people with serious illness vary widely and that limited knowledge or awareness of PAT research is generally associated with greater scepticism. Despite this variability, many HCWs expressed openness to PAT as a potential means to relieve refractory existential and psychological distress, while simultaneously identifying social, political, and economic barriers to implementation. The authors emphasised the need to address societal stigma, provide formal PAT education for HCWs in palliative contexts, pursue rigorous research to clarify delivery questions, and adopt multidisciplinary approaches if PAT is to be implemented responsibly.