Psilocybin-assisted therapy for demoralisation in hospice patients: feasibility, safety and preliminary efficacy
In an open‑label pilot where 10 hospice patients received a single 25 mg psilocybin‑assisted therapy session, the intervention was feasible and well tolerated with no serious psilocybin‑related adverse events and produced a significant reduction in demoralisation at three weeks (mean reduction 8.8 points, p=0.0196). Acceptability varied because of the intervention’s emotional intensity, indicating PAT can be integrated into hospice care but requires optimisation and larger controlled trials.
Abstract
Objectives
To assess the feasibility, safety and preliminary efficacy of psilocybin-assisted therapy (PAT) for demoralisation in terminally ill patients receiving home hospice care.
Methods
In this open-label pilot trial, 4607 home hospice patients at a large community hospice were screened over 22 months; 66 were approached, 15 enrolled and 10 received psilocybin. Participants completed two home-based preparation sessions, a single 25 mg oral psilocybin session at an inpatient hospice facility, and two home-based integration sessions. Feasibility was assessed through recruitment, retention and acceptability. Safety was evaluated via adverse event monitoring, and preliminary efficacy was assessed using changes in demoralisation scores and other psychosocial measures.
Results
The intervention was well tolerated, with no serious adverse events attributed to psilocybin. At week 3, demoralisation scores significantly decreased (mean reduction: 8.8 points, p=0.0196), despite ongoing clinical decline. Grief- and peace-related themes were prominent during psilocybin sessions. While six participants rated the treatment favourably on the Reaction to Research Participation Questionnaire global evaluation factor, three rated neutral on one or more items, suggesting that the emotional intensity and demands of the intervention may influence acceptability.
Conclusion
This study provides initial evidence that PAT can be feasibly and safely integrated into hospice care for terminally ill patients. Further research is needed to optimise delivery and further assess therapeutic potential.
Research Summary of 'Psilocybin-assisted therapy for demoralisation in hospice patients: feasibility, safety and preliminary efficacy'
Introduction
Beaussant and colleagues situate this study within evidence that psilocybin-assisted therapy (PAT) can reduce depression, anxiety and demoralisation in people with serious illness, noting that prior trials predominantly enrolled patients with relatively preserved functional status. They argue that terminally ill patients receiving hospice care experience particularly intense psycho-existential distress—commonly labelled demoralisation—which is distinct from major depression and characterised by hopelessness, loss of meaning and a thwarted desire to cope. The introduction highlights that hospice patients have been largely excluded from prior research and that their rapid clinical decline, emotional vulnerability and reliance on interdisciplinary and family-based care raise specific logistical and ethical questions about PAT implementation. This study therefore aims to evaluate the feasibility, safety and preliminary efficacy of a manualised PAT protocol for demoralisation in patients enrolled in home hospice. The investigators designed a prospective, open-label pilot trial to test whether PAT can be integrated into hospice care, assess recruitment and retention, describe adverse events, and measure changes in demoralisation and related psychosocial outcomes, with special attention to real-world operational challenges and patient acceptability.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Author
- APA Citation
Beaussant, Y., Sager, Z., Brennan, C., Kristan, I., Ljuslin, M., Mazzola, E., Macdonald, D., Murphy, M. E., Nigam, K., Rinaldi, A. D., Sanders, J., Schaefer, K. G., Sholevar, R., Summer, L., Waliji-Banglawala, A., Yudilevich-Espinoza, S., & Tulsky, J. A. (2026). Psilocybin-assisted therapy for demoralisation in hospice patients: feasibility, safety and preliminary efficacy. BMJ Supportive & Palliative Care, 16(2), 423-433. https://doi.org/10.1136/spcare-2025-005773
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