Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies
Interviews with 19 palliative care clinicians found existential distress to be common and often inadequately treated within current, largely non‑medicalised frameworks. Providers regarded psychedelic‑assisted therapies as a promising option for refractory existential distress but emphasised the need for larger trials, clinician education, adapted care models that integrate spiritual and mental‑health expertise, and measures to ensure safety and equitable access.
Authors
- Benjamin Kelmendi
Published
Abstract
Background
Existential 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.
Methods
The 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.
Results
Nineteen 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.
Conclusions
PAT 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.
Research Summary of 'Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies'
Introduction
Existential distress—overlapping with spiritual distress, demoralisation and loss of meaning—produces substantial suffering for patients facing life-threatening illness (LTI). Prior research indicates limited effectiveness of conventional pharmacological and psychotherapeutic approaches in this population, and recent Phase II studies of psychedelic-assisted therapies (PAT) such as psilocybin, MDMA and ketamine have shown promising reductions in depression, anxiety and fear of death in patients with cancer, with some trials reporting benefits persisting in 60-80% of survivors at six months. Despite encouraging early efficacy signals, stigma around psychedelics and limited clinician education remain barriers to broader clinical uptake, and how PAT might be integrated into multidisciplinary palliative care practice is underexplored. Niles and colleagues set out to characterise attitudes among palliative care clinicians toward current treatments for existential distress and toward PAT as potential interventions for distress associated with LTI. To do so they conducted a qualitative study using semi-structured interviews of a multidisciplinary US sample, aiming to identify common themes about existing practice, perceived gaps in care, and opportunities or barriers for PAT integration into palliative care.
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Study Details
- Study Typeindividual
- Journal
- Topics
- Author
- APA Citation
Niles, H., Fogg, C., Kelmendi, B., & Lazenby, M. (2021). Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies. BMC Palliative Care, 20(1). https://doi.org/10.1186/s12904-021-00889-x
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