This mixed-methods survey study (n=93) of Australasian palliative care doctors found that 75% disagreed psychedelics are unsafe and should be prohibited for medical use, and 88% agreed clinical use in palliative patients warrants further investigation, with younger respondents more likely to believe psychedelics may improve outcomes. Twelve follow-up interviews identified themes including openness to innovation, safety, and access equity.
Psychiatric symptoms and existential distress are common at the end of life and associated with poor outcomes. Psychedelic therapies are an emerging option for managing such patients, but their testing and application depends, inter alia, on prescribers’ perspectives. However, no published data exist on the opinions of Australasian palliative care medical staff regarding psychedelic safety and efficacy. This exploratory mixed-methods study used a cross-sectional survey, together with an optional semi-structured interview, to explore attitudes among consultant and trainee members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM).
Quantitative Arm
Of 580 invitations, 93 questionnaires were returned (16%). Seventy respondents (75%) disagreed that psychedelics are unsafe and should be prohibited for medical use, while 82 (88%) agreed clinical use for palliative patients warrants further investigation. Younger respondents were more likely than their older colleagues to believe psychedelics may improve clinical outcomes.
Qualitative Arm
Twelve interviews were completed; 8 interviewees were female and 7 were consultants. Analysis identified five themes: openness to innovation, safety, patient-centred care, therapeutic potential, and access and equity.
Limited evidence suggests psychedelic therapies are generally safe and can be effective for treating existential distress and psychiatric symptoms at end of life. Alongside clinical trials, the legal and regulatory landscape is evolving. Findings from this exploratory study suggest that Australasian palliative care doctors hold cautious but generally positive attitudes toward psychedelics and support further research to establish their role in palliative care.
Papers cited by this study that are also in Blossom
Barnett, B. S., Arakelian, M., Beebe, D. et al. · Psychedelic Medicine (2024)
Barnett, B. S., Siu, W. O., Pope Jr, H. G. · Journal of Nervous and Mental Disease (2018)
Carhart-Harris, R. L., Goodwin, G. M. · Neuropsychopharmacology (2017)
Johansen, P. Ø., Krebs, T. S. · Journal of Psychopharmacology (2015)
The introduction sets out that there has been renewed clinical interest in psychedelic medicines, with earlier reviews suggesting possible benefits for existential distress, anxiety, and depression in people with terminal illness. At the same time, the paper notes that evidence remains limited by small studies, blinding problems, expectancy effects, and other methodological challenges. The authors also situate the topic within a changing legal context: Australia has allowed authorised psychiatrists to prescribe MDMA for post-traumatic stress disorder and psilocybin for treatment-resistant depression, whereas New Zealand still restricts routine clinical use. Against this background, they argue that clinician attitudes matter because they influence research, education, and eventual implementation. The study aimed to examine the perspectives of Australasian palliative care doctors on the safety and efficacy of psychedelic medicines. The authors state that palliative care physicians are an important group because psychiatric symptoms and existential distress are common at the end of life, yet conventional options can be unsatisfactory. The paper therefore seeks to provide exploratory evidence on whether these clinicians view psychedelic-assisted therapy as potentially useful, safe, and worth further study in palliative care. The authors frame the work as filling a gap, because prior attitude studies had focused on psychiatrists or broader healthcare groups, while the views of palliative care specialists in Australia and New Zealand had not been described.
Sawers and colleagues used an exploratory concurrent mixed-methods design. Quantitative and qualitative data were collected in parallel, analysed separately, and then integrated to give a fuller picture of clinicians’ attitudes. The study was explicitly descriptive and hypothesis-generating rather than powered to produce population-level estimates. The quantitative arm was an anonymous cross-sectional online questionnaire distributed by email through the Australian and New Zealand Society of Palliative Medicine to all 580 member physicians and trainees in Australia and New Zealand. The survey was open from April to August 2023, with one reminder sent after three months. Completion implied consent. The questionnaire was adapted from a previously published clinician-attitude survey, retained items on safety, legality, and therapeutic potential, and added palliative-care-specific items. It included demographic questions and Likert-scale statements about psychedelic medicines. No formal pilot testing or cognitive pretesting was conducted. For the qualitative arm, respondents could volunteer for an optional semi-structured interview after completing the survey. Interviews were conducted by Zoom, recorded with consent, transcribed, de-identified, and offered back to participants for transcript review and amendment. The interview guide used visual prompts with the words psilocybin, MDMA, the future, concerns, patient perspectives, and assisted dying, followed by open-ended questions tailored to each participant’s answers. Survey data were summarised descriptively and associations between attitudes and demographic variables were examined using Fisher’s Exact Test in SPSS version 29. No formal correction for multiple comparisons was applied, so p-values were treated as descriptive signals. Qualitative interview data were manually coded in NVivo 14, with one interview independently coded by a second author and themes developed through an iterative three-stage approach. Ethical approval was obtained from the Auckland Health Research Ethics Committee.
In the quantitative arm, 93 of 580 invited clinicians responded, a 16% response rate. The sample included 63 women, 29 men, and one participant who did not disclose gender. The authors note that the proportion of trainees and non-consultant medical officers was broadly comparable with membership data, although New Zealand doctors were over-represented relative to Australian doctors. Overall attitudes were cautious but mostly favourable. About half of respondents thought psychedelic use might increase the risk of subsequent psychiatric disorders, yet the majority disagreed that psychedelics are unsafe even under medical supervision. Around half agreed that psychedelic use should remain illicit for recreational purposes, but 82% disagreed that psychedelics should be illegal for medical use. Fifty-four per cent agreed that psychedelics show promise for palliative patients, two-thirds agreed they may improve outcomes when combined with psychotherapy, and 88% agreed they warrant further research in palliative care. Some subgroup differences were reported. Younger respondents were more likely than older respondents to believe psychedelics may improve outcomes, and no respondents under 40 years old said psychedelics were unsafe under medical supervision or should be prohibited for medical use. There were no statistically significant differences by gender, stage of training, or years of experience. Slightly more New Zealand than Australian respondents agreed that further research was warranted, and a small number of Australian respondents thought medical use should be prohibited, whereas none of the New Zealand respondents did. In the qualitative arm, 12 interviews were completed, each lasting about 25-30 minutes. Interviewees were aged 38-56 years; two-thirds were women and just over half were consultants. Five themes were identified. First, participants expressed openness to innovation and saw palliative care as a field suited to exploring novel therapies. Second, safety concerns were central, including worries about harm, ethical issues, and the need for evidence-based practice; some participants compared possible risks with past prescribing harms in medicine. Third, patient-centred care and shared decision-making were emphasised, with several interviewees saying that patient preference should strongly shape decisions. Fourth, participants saw possible therapeutic benefit, especially for existential distress and psychiatric symptoms at the end of life, but stressed the need for rigorous trials. Fifth, participants raised access and equity concerns, including affordability, funding, and the possible influence of commercial interests. The authors report that thematic saturation was reached after the first six interviews and the next six added only minor refinements. No participant withdrew from interviews, and no item-level survey data were missing.
The authors interpret the findings as showing that Australasian palliative care doctors generally hold cautious but positive views about psychedelic medicines. They describe this as the first study of its kind in this professional group and say the results are consistent with earlier work in other clinician populations, including studies from the United States and New Zealand that found neutral-to-positive views alongside concerns about regulation, access, and side effects. Sawers and colleagues argue that respondents’ apparent receptiveness reflects both the limitations of current palliative treatments and the emerging evidence that psychedelic-assisted therapy may help with existential distress, anxiety, and depression at the end of life. They note, however, that concern about psychiatric risk remains important and has historical roots in earlier stigma around psychedelics. The authors say the interviews captured nuanced safety concerns rather than simple enthusiasm, but that most respondents still rejected the idea that psychedelics are unsafe under medical supervision or should be prohibited for medical use. The discussion places the findings alongside evidence that has accumulated on supervised psychedelic use, while also acknowledging that regulators have not uniformly endorsed these therapies; for example, the paper mentions the FDA’s recent decision not to authorise MDMA-assisted therapy for post-traumatic stress disorder. The authors also highlight that the evidence base in life-threatening illness remains low certainty, with small studies, heterogeneity, and other methodological limitations, so the current findings should be interpreted cautiously. The paper emphasises a younger-age effect in the survey, with younger clinicians more likely to believe psychedelics may improve outcomes. The authors suggest this may reflect differences in exposure to newer literature or broader cultural change. They report no gender difference in their sample, unlike some previous studies. They also discuss the idea that psychedelic therapies could become relevant for patients considering medically assisted dying, but they frame this as ethically complex and not yet resolved. The authors identify several implications for practice and research: if psychedelic therapies are to be integrated into palliative care, there will need to be clear protocols, clinician training, careful risk management, and attention to shared decision-making. They also stress that access, affordability, and cost-effectiveness will matter, particularly if commercial models shape delivery. The main limitations they acknowledge are the adapted questionnaire without formal pilot testing, the modest 16% response rate and possible non-response bias, the cross-sectional design, the small qualitative sample, time constraints in interviews, and the under-representation of some perspectives, including indigenous viewpoints. They conclude that larger and more diverse studies are needed, including research that follows attitudes over time.
The authors conclude that research suggests psychedelic therapies may be generally safe and effective for existential distress and psychiatric symptoms at the end of life, although the implementation environment is still changing. They say their study indicates Australasian palliative care doctors are cautiously, but generally, positive about psychedelic use in clinical practice and supportive of further research. The final emphasis is on patient-centred care, autonomy, and determining which medicinal and psychotherapeutic approaches are acceptable and effective in palliative settings.
To explore current perspectives of palliative care physicians in Australia and New Zealand, this exploratory study used a concurrent mixed-methods design, including a cross-sectional questionnaire survey followed by an optional semi-structured interview. Data from both sources were collected in parallel during the same study period, analysed separately and integrated to provide complementary perspectives on respondent attitudes. This approach aligns with established mixedmethods frameworks that emphasise the value of combining numerical description with in-depth exploration of meaning and context. While these substances were initially grouped under a broad 'psychedelic' category, they have differing pharmacological profiles, legal status, and risk considerations; accordingly, MDMA, ketamine, and psilocybin were considered distinct in the qualitative analysis to explore these differences in more detail. Participants were eligible if registered as palliative care physicians or trainees currently practicing in Australia or New Zealand and were members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM). Participants were also required to provide informed consent to participate in the survey and, optionally, the follow-up interview. Given the sampling approach and anticipated response rate, the study was intended to generate preliminary, hypothesis-generating insights rather than population-level estimates.
The questionnaire (Supplementary File 1) was adapted from a previously published survey used to examine clinician attitudes toward psychedelic therapies in medical contexts. Items relating to safety, legality, and perceived therapeutic potential were retained to preserve comparability with the original instrument, and additional items developed to explore potential applications in palliative care. The questionnaire consisted of two sections; the first collected demographic information including age, gender, country of practice, and professional training level; the second included closed-ended Likert-scale items assessing attitudes toward the safety, legality, and potential therapeutic role of psychedelic medicines in palliative care. Questionnaire results are reported in accordance with the Checklist for Reporting of Survey Studies; all survey questions are reported in Tables 1-7 and a completed checklist included in Supplementary File 2. No formal pilot testing or cognitive pretesting was conducted prior to distribution. The questionnaire should therefore be regarded as an adapted exploratory instrument.
The study setting was entirely online, surveying clinicians in Australia and New Zealand. Invitations were distributed via email from the ANZSPM to all members, both specialists and trainees, across both countries. The survey was open for five months between April and August 2023; a reminder email was distributed after three months.
The survey was anonymous. No identifying information such as names, email addresses, or IP addresses were collected. The invitation email contained an information sheet describing the purpose of the study, voluntary participation, and data handling procedures. Completion and submission of the questionnaire were explicitly taken as implied consent. Data were stored in password-protected accounts accessible only to the research team and handled in accordance with the requirements of the relevant New Zealand ethics committee.
The ANZSPM mailing list included 580 physicians and trainees. Similar surveys typically have a 10-20% participation rate. Accordingly, we expected approximately 60-100 questionnaire responses and a smaller number of interview volunteers. As this study is descriptive and exploratory, statistical power calculations were not considered relevant. Data from the survey were collected anonymously and managed using Google Forms. The survey platform restricted submissions to one response per device session. No incentives were offered, reducing the likelihood of duplicate participation. We calculated summary descriptive statistics for each survey item and assessed whether attitudes to psychedelics were associated with demography using SPSS (Version 29). The associations and differences between groups were examined using Fisher's Exact Test. As the study was exploratory and hypothesisgenerating, formal correction for multiple comparisons was not applied. Reported p-values should therefore be interpreted as descriptive signals rather than definitive evidence of subgroup differences. All submitted questionnaires were complete, with no missing item-level data observed.
Upon completion of the online questionnaire participants could anonymously opt to signal interest in a follow-up interview. Those expressing interest were emailed a participant information sheet, consent form, and data privacy information. Participant interviews by Zoom were arranged by email. Participants were given the option to withdraw from interviews at any time; none did so.
The semi-structured interview used visual prompts alongside openended questions. At the beginning of the interview, participants were informed that the interviewer would show them visual prompts on six separate sheets of paper and invite them to share thoughts, feelings, and opinions about each in relation to psychedelics and palliative care; the sheets displayed in large font the words 'psilocybin', 'MDMA', 'the future', 'concerns', 'patient perspectives' and 'assisted dying'. The prompts were intended to allow the participants to guide the direction of the interview, to leave space for interpretation, and to avoid leading questions. Further open-ended questions were tailored to the context of the participant's initial responses and aimed to elicit more in-depth insights. Examples included prompts such as, "Could you tell me more about that in relation to your clinical practice?" or "What is your opinion on that issue?". Such questions were particularly used when participants' answers were primarily factual. The interviews took twenty-five minutes on average to complete. The relatively short duration was intended to gather essential information while minimizing disruption to participant working days. Participant responses to the prior questionnaire survey were available to the interviewer (author NS) to refine and guide discussion.
Zoom interviews were recorded with the written consent of participants, transcribed, de-identified, and stored securely in a password protected MP4 file. To ensure accuracy, participants were given the opportunity to review transcripts and asked to return them within seven days with any required edits, additions or deletions.
Interview data were manually coded in nVivo 14 software. One randomly selected interview was independently coded by a second author (MB). Coding practice was to use 'code segments' longer than a few words but shorter than a paragraph. Data analysis and theme identification was guided by an established three stage approach. After reviewing the collected data, coding and analysis aimed to develop meaningful themes using a refined codebook. Thematic review of transcripts was used to discuss and iteratively refine themes with all authors.
This study was reviewed and approved by the Auckland (New Zealand) Health Research Ethics Committee (AHREC Reference: AH24809).
Of 580 palliative care doctors contacted via email, 93 (16%) completed the questionnaire, of whom 63 were female, 29 male, and one preferring not to disclose. All but one practiced in a region permitting medically assisted dying. Tablesummarizes respondent demographics. According to the ANZSPM 2022-2023 annual report (Australian and New Zealand Society of Palliative Medicine, 2023), trainees constitute approximately 25% of total membership. The proportion of trainees and non-consultant medical officers (19%) in our sample is broadly comparable, suggesting no major over-or under-representation of training status. On the other hand, New Zealand doctors were over-represented compared to Australians (38% versus 9.4% of those eligible completing the questionnaire) but there was little evidence of attitudinal differences by country, as shown in later tables. Aggregate ANZSPM data on age and gender distribution were not publicly available, limiting further assessment of demographic representation. Tablepresents summary opinions on psychedelics; while half (49.5%) of respondents considered use may increase the risk of subsequent psychiatric disorders, the majority disagreed with the statement that the use of psychedelics is unsafe, even under medical supervision. Similarly, about half agreed that the use of psychedelics should remain illicit for recreational purposes, but a large majority (82%) disagreed that psychedelics should be illegal for medical use and 54% agreed that their use shows promise in the management of palliative patients. Two-thirds of respondents agreed that the use of psychedelics may improve outcomes when combined with psychotherapy, and a clear majority (88%) agreed that the use of psychedelics warrants further research for treatment for palliative patients. Differences between respondent groups were examined using Fisher's Exact Test. As shown in Table, younger respondents (76%) were significantly more likely to opine that use of psychedelics may improve outcomes compared to older respondents (64%), p < 0.05. No respondents less than 40 years old believed psychedelics to be unsafe under medical supervision or that they should be prohibited for medical use. No statistically significant differences could be found between genders (Table), stages of training, or years of post-graduate experience (Tablesand). Slightly more respondents from New Zealand (92%) than Australia (84%) agreed that use of psychedelics for the treatment of palliative patients warrants further research (Table). A small number (n = 7) of Australian respondents thought that medical use of psychedelics should be prohibited while none from New Zealand endorsed such an opinion.
Twelve video interviews were completed, each lasting 25-30 min. Interviewees ranged between 38 and 56 years of age; two thirdswere female and just over halfpractising at consultant level. Thematic saturation was defined as the point at which no new themes or conceptual categories emerged during iterative coding and analysis of interview transcripts. Saturation was initially assessed after six interviews, at which point five core themes had been identified. A further six interviews were conducted to confirm saturation, during which no new themes emerged, with only minor sub-themes and refinements identified, adding depth rather than altering the thematic framework. Themes included:
Interviewees consistently expressed curiosity and openness towards innovative therapies, including those that integrate use of psychedelic medicines. This theme also consistently reflected awareness of the limitations of currently available treatments. Moreover, it recognised the necessity to explore novel approaches, including psychedelics, in addressing the complex needs encountered in palliative care. Participants repeatedly expressed the view that palliative care doctors are wellsuited to working with psychedelics because they are already accustomed to supporting patients through experiences that involve uncertainty, existential distress, and spiritual exploration. Their openness to non-traditional ways of understanding suffering and healing was seen as aligning well with the nature of psychedelic-assisted therapy. Example statements included:
"Psychedelics could be another tool in the toolkit knowing that it won't work for everyone"
Safety considerations emerged as a central theme in discussions regarding the potential therapeutic use of psychedelics. Concerns included the potential for harm, ethical implications, and the imperative of practice based on evidence. Most participants acknowledged that the medical profession tends to be risk-averse, as reflected in uncertainty regarding the use of psychedelics in conventional clinical practice. There were also concerns raised about longer-term effects. Participants prioritised safety and patient well-being, emphasising an open, yet cautious approach to consideration of psychedelic-assisted therapies. Example statements included: "Ultimately, it comes down to not wanting to do harm." "I think of the opioid crisis which was perpetuated through prescriptions from doctors. I am worried the same thing will happen in psychedelics." "There is often a fine line between uncertainty and dangerous (practice) …we can often confuse the two."
Respect for patient autonomy and preferences appeared repeatedly in the interviews. Participants highlighted the importance of empowering patients through education about potential benefits and harms of novel therapies, as well as alternative treatment options. This was felt to be especially true regarding psychedelics, with a clear emphasis on informed and shared decision-making. Many participants expressed commitment to supporting patient decisions, indicating willingness to advocate for the use of psychedelics if aligned with patient preference. In the context of psychedelic-assisted therapy, several participants advocated a move away from traditional, expert-driven decisions toward a non-directive, collaborative approach. Example statements included: "I think it's important that a person gets a chance to take some control of their own destiny"
"Perhaps the environment and the space we can provide is most important and the patients will actually be healing themselves"
Despite the concerns surrounding the use of psychedelics, a sense of optimism was evident in participant discussions regarding possible therapeutic benefits. Many of the participants were keen to discuss the potential efficacy of psychedelics in relieving existential distress and psychiatric symptoms experienced at the end of life. All participants endorsed the need for further research and rigorous clinical trials to support these claims and strengthen the evidence base for psychedelic therapies. There was general agreement that managing existential suffering is challenging, current therapeutic options often inadequate, and a sense of hope regarding the prospect of psychedelic-assisted therapies to support patients' final journey. "There's still suffering at the end of life for some people which can't be taken away by the drugs we currently have." "Many of the important aspects we see are not physical issues. They are spiritual, existential, and psychological issues."
Participants discussed the equitable use of psychedelic therapies, including availability, affordability, and funding. Participants emphasised that promising therapies, including psychedelics, should be accessible to individuals from diverse socioeconomic and cultural backgrounds, advocating policies to ensure equitable access. Several voiced concerns about the likely impact of commercial interests and the actual cost of treatments.
"Cost is a big concern if it's going to be developed by pharmaceutical companies. How much you're going to be charged and will it be funded. Who will prescribe it?"
This is the first study aimed at describing the perspectives of Australasian palliative care doctors on the clinical use of psychedelic medicines. While previous studies have explored the attitudes of psychiatrists, the views of palliative care specialists in Australia and New Zealand have remained unexplored. Our findings are consistent with those reported in the United States, where research has similarly identified cautious interest among palliative care clinicians in the potential role of psychedelic-assisted therapies in palliative and end-of-life care. A recent, New Zealand-based systematic review of studies of demographically diverse samples found neutral to positive views in the therapeutic potential of psychedelics, general endorsement of the need for further research and consistent concerns regarding legal status, funding, access, and side-effects. We found that respondents expressed various, mainly positive, opinions regarding the potential efficacy of psychedelic medicines at end of life. The idea that psychedelics can increase psychosis risk has been evident since the 1960s and resulted in considerable stigma and reluctance to consider their clinical use. However, large epidemiological studies have failed to identify increased risk of mental illness associated with psychedelic use. A 7-year follow up study of attitudes of psychiatrists towards classic hallucinogens found increasing optimism regarding therapeutic potential and decreased concern about risks. Our data indicated respondent uncertainty regarding risk of psychiatric disorder following psychedelic use, as well as curious and largely receptive views of psychedelics identified in the thematic analysis. Aligning with this more open perspective; most respondents disagreed or strongly disagreed with statements that psychedelics are unsafe, even under medical supervision, or that they should be prohibited for medical use. While evidence has accumulated that psychedelics can be safely administered under medical supervision, a recent review by the FDA declined to authorise MDMA-assisted therapy for post-traumatic stress disorder, citing Group difference for each item assessed with Fisher's Exact Test. concerns over adverse event reporting and allegations of sexual misconduct by one practitioner. Concerns about the safety of psychedelic medicines were well reflected in this study's interviews, which described nuanced apprehensions regarding safety, risks of harm, and potential ethical implications. Most respondents viewed psychedelics as showing promise in the management of palliative patients when combined with psychotherapy, particularly for managing existential distress and psychiatric symptoms at the end of life, consistent with emerging research. However, the overall evidence base remains limited, as shown in a recent Cochrane reviewhighlighting low certainty evidence regarding efficacy of psychedelic-assisted therapy in life-threatening illness, citing small sample sizes, methodological limitations, and heterogeneity across studies. These findings underscore the need for cautious interpretation of existing results. Accordingly, a clear majority of our respondents emphasized the importance of further rigorous research to better establish the safety and efficacy of psychedelics in palliative settings. Our findings were fairly consistent, with little apparent difference between demographic and professional groups within the sample. In contrast to previous findings, we found no difference in attitudes toward psychedelics based on gender. An age effect was, however, apparent, as shown in Table: practitioners less than 40 years old were significantly more likely to hold the view that the use of psychedelics may improve outcomes compared to older respondents. No respondents less than 40 years old considered psychedelics to be unsafe or that they should be prohibited for medical use. This may reflect generational differences in exposure to recent literature and evolving cultural perspectives. Concerns about the efficacy and tolerability of conventional palliative treatments may lead to patients seeking additional treatment options, including medically assisted dying. All but one respondent practiced in an area that permitted this practice and a strong majority of respondents (84%) were either neutral or held the opinion that psychedelics could provide an alternative for patients who might otherwise opt to pursue a medically assisted death. How psychedelic-assisted therapies might best be integrated with existing palliative interventions remains an open question, likely to be influenced by future research and evolving policy. These therapies may offer new pathways for managing suffering, especially considering palliative care's traditional opposition to medically assisted dying. However, framing psychedelic therapies as a potential alternative to assisted dying raises important ethical questions about safeguards, informed consent, vulnerability, and the proper place of promising but still uncertain treatments. Our qualitative findings have implications for the integration of psychedelic therapies into palliative care. Physicians' openness to innovation suggests readiness to explore novel approaches with a focus on safety, highlighting the need for clear protocols, training, and careful risk management. Emphasis on patient-centred care indicates that shared decision-making and a supportive environment are critical aspects for the future of psychedelics in palliative care. The themes of therapeutic potential and access and equity point to broader research and policy priorities. Physicians expressed cautious optimism and the need for robust clinical trials to guide practice. Concerns about cost, equitable access, and commercial influence highlight the importance of ensuring that interventions are available to those likely to benefit. Taken together, these insights suggest that safe, effective, and ethically sound integration of psychedelic therapies will require careful consideration of access, resourcing, and costeffectiveness. Given that medically assisted dying is now available in New Zealand and several Australian jurisdictions, psychedelic therapies may represent a meaningful alternative for patients and families seeking relief from existential suffering without hastening death. This study suggests that the role of these therapies within broader palliative practice warrants further exploration.
A strength of this study is its combined quantitative and qualitative methodology. While enabling a meaningful exploration of opinions, qualitative methods are often underrepresented in attitudinal research. Qualitative approaches importantly enable exploration of social, cultural, and environmental influences shaping opinion and perception. For example, our semi-structured interviews highlighted several important perspectives not captured by the questionnaire. These included advocating for equity in policies, patient and staff education, the practice of patient centred care and shared decision-making. Future research could explore these attitudes in greater detail. This study had several limitations. First, because the questionnaire was adapted and not formally pilot tested, measurement validity should be interpreted cautiously. Second, our sample size of 93 respondents represents a modest response rate (16%) and indicates a risk of non-response bias. It is plausible that clinicians with stronger pre-existing views about psychedelic therapies, whether favourable or skeptical, were more likely to participate. Consequently, our findings should thus be regarded as descriptive of respondent attitudes and may not represent the broader population of Australasian palliative care physicians and trainees. At the same time, response rates of this magnitude are not uncommon in physician survey research, particularly in unsolicited emailbased studies. The primary aim of the quantitative arm was exploratory: to map the range and internal structure of attitudes of participating palliative care doctors, and to identify signals that could inform future, larger-scale investigations. Larger samples would allow for more stable subgroup analyses and strengthen the external validity of conclusions. A third limitation in the quantitative arm is its cross-sectional nature. Following up their earlier studyafter seven years, Barnett and colleagues found a positive shift in psychiatrist attitudes toward the therapeutic potential of psychedelics, possibly reflecting the pace of developments in the field. Further studies could look to track the perceptions of palliative care specialists in Australia and New Zealand over time. The qualitative arm of the study was limited by the time availability of interviews. As it was challenging to schedule interviews with busy clinicians, interviews were limited to thirty minutes. This time constraint meant that several topics of interest could not be explored in depth. These included prescribed cannabis as an alternative to psychedelics and, perhaps more importantly in both Australia and New Zealand, indigenous perspectives on the sacred nature of psychedelics and altered states generally. Interview participants were mainly female, consultant level, and over 40 years old. Our results accord with the literature that age may influence attitudes toward psychedelics, while previous work also indicates a possible role of gender. Larger studies with a more diverse range of participants may thus be useful to consider in further research. Our recruitment strategy relied on a single email distribution via a professional society mailing list, without incentives or multiple followup strategies. This may have limited engagement, particularly among clinicians with competing clinical demands or lower baseline interest in the topic. Future studies could consider multi-modal recruitment approaches, shorter survey instruments, or targeted follow-up to improve participation rates and subgroup representation.
Research into psychedelic therapies suggests that they may be generally safe and effective for the treatment of existential distress and psychiatric symptoms at end of life. The legal status and implementation of these treatments is rapidly evolving. This study suggests that Australasian palliative care doctors hold cautious but generally positive attitudes toward the use of psychedelics in clinical practice. Respondents were also encouraging of more research into novel treatments, with a focus on patient-centred care and promoting autonomy. These findings align with international trends and underscore the growing multidisciplinary interest in psychedelic therapies and how these may be integrated into personalised and compassionate end-of-life care. Of particular relevance will be determining which treatments, medicinal and psychotherapeutic, are acceptable and effective in this setting.
Create a free account to open full-text PDFs.
Niles, H., Fogg, C., Kelmendi, B. et al. · BMC Palliative Care (2021)
Ross, S., Bossis, A. P., Guss, J. et al. · Journal of Psychopharmacology (2016)
Stocker, K., Liechti, M. E. · Journal of Psychopharmacology (2024)
Studerus, E., Kometer, M., Hasler, F. et al. · Journal of Psychopharmacology (2010)