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Masse-Grenier M, Chang SL, Bélanger A, Stephan JF, Hébert J, Deschamps P, Plourde L, Provost F, Farzin H, Fallu JS, Dorval M. What do health professionals think about implementing psilocybin-assisted therapy in palliative care for existential distress? A World Café qualitative study. Palliat Support Care 2024:1-11. [PMID: 39379285 DOI: 10.1017/s1478951524001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
OBJECTIVES Promising studies show that psilocybin-assisted therapy relieves existential distress in patients with serious illnesses, a difficult condition to treat with current treatment options. There is growing interest in this therapy in palliative care. Canada recently amended its laws to allow physicians to request psilocybin for end-of-life distress. However, barriers to access remain. Since implementing psilocybin-assisted therapy within palliative care depends on the attitudes of healthcare providers willing to recommend it, they should be actively engaged in the broader discussion about this treatment option. We aimed (1) to identify issues and concerns regarding the acceptability of this therapy among palliative care professionals and to discuss ways of remedying them and (2) to identify factors that may facilitate access. METHODS A qualitative study design and World Café methodology were adopted to collect data. The event was held on April 24, 2023, with 16 palliative care professionals. The data was analyzed following an inductive approach. RESULTS Although participants were interested in psilocybin-assisted therapy, several concerns and needs were identified. Educational and certified training needs, medical legalization of psilocybin, more research, refinement of therapy protocols, reflections on the type of professionals dispensing the therapy, the treatment venue, and eligibility criteria for treatment were discussed. SIGNIFICANCE OF RESULTS Palliative care professionals consider psilocybin-assisted therapy a treatment of interest, but it generates several concerns. According to our results, the acceptability of the therapy and the expansion of its access seem interrelated. The development of guidelines will be essential to encourage wider therapy deployment.
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Affiliation(s)
- Marianne Masse-Grenier
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sue-Ling Chang
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Ariane Bélanger
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | | | - Johanne Hébert
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
- Department of Health Sciences, UQAR, Lévis, Rimouski, QC, Canada
- CISSS of Chaudière-Appalaches Research Center, Lévis, QC, Canada
| | - Pierre Deschamps
- McGill Research Group on Health and Law, McGill University, Montréal, QC, Canada
| | - Louis Plourde
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - François Provost
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Houman Farzin
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montréal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Jean-Sébastien Fallu
- School of Psychoeducation, Université de Montréal, Montréal, QC, Canada
- Center for Public Health Research (CReSP), Montréal, QC, Canada
- Institut universitaire sur les dépendances (IUD), Montréal, QC, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
- CISSS of Chaudière-Appalaches Research Center, Lévis, QC, Canada
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Foo BMY, Sharpe L, Clayton JM, Wiese M, Menzies RE. The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review. Clin Psychol Rev 2024; 110:102393. [PMID: 38615491 DOI: 10.1016/j.cpr.2024.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.
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Affiliation(s)
- Baby M Y Foo
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Josephine M Clayton
- The Palliative Centre, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Australia.
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, New South Wales 2751, Australia.
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
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3
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Žuljević MF, Breški N, Kaliterna M, Hren D. Attitudes of European psychiatrists on psychedelics: a qualitative study. Front Psychiatry 2024; 15:1411234. [PMID: 38855648 PMCID: PMC11157110 DOI: 10.3389/fpsyt.2024.1411234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction and aim It is important to understand how mental health practitioners view recent findings on psychedelic-assisted psychotherapy (PAP) as there is potential this treatment may be incorporated into clinical practice. The aim of our study was to explore how psychiatrists who are not involved in psychedelic research and who are located in the European region perceive psychedelics and PAP. Methods We conducted online semi-structured interviews with 12 psychiatry specialists and psychiatry trainees from 8 European countries. Data were analyzed using a general inductive approach informed by codebook thematic analysis. Results Based on the interviews, we developed four main themes and 14 sub-themes, including (1) Psychedelics hold potential, (2) Psychedelics are dangerous, (3) Future of psychedelics is uncertain, and (4) Psychiatry is ambivalent toward psychedelics. Discussion Our respondents-psychiatrists acknowledged the potential of PAP but remained cautious and did not yet perceive its evidence base as robust enough. Education on psychedelics is lacking in medical and psychiatric training and should be improved to facilitate the involvement of mental health experts in decision-making on PAP.
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Affiliation(s)
- Marija Franka Žuljević
- Department of Medical Humanities, School of Medicine, University of Split, Split, Croatia
| | - Nando Breški
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Mariano Kaliterna
- Department of Medical Humanities, School of Medicine, University of Split, Split, Croatia
| | - Darko Hren
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
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4
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Bellman V. Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon. Cancers (Basel) 2024; 16:1702. [PMID: 38730654 PMCID: PMC11083170 DOI: 10.3390/cancers16091702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite the legalization of psilocybin therapy for depression in terminal illnesses such as advanced cancer through Oregon's Measure 109 in 2020, significant challenges have impeded its implementation. This review synthesizes the empirical data supporting the utilization of psilocybin therapy for addressing cancer-related depression, including an evaluation of its purported benefits and potential adverse effects. It provides a comprehensive examination of therapeutic strategies, dosing regimens, and barriers to ensuring responsible and equitable access. Salient issues explored include the development of ethical protocols, integration within healthcare systems, ensuring statewide availability, resolving legal ambiguities, and defining clinical standards. Oregon's pioneering role serves as a case study, highlighting the necessity of addressing regulatory, logistical, and ethical obstacles to ensure the establishment of rigorous and equitable psilocybin care models.
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Affiliation(s)
- Val Bellman
- Psychiatry Residency Training Program, University of Missouri Kansas City, Kansas City, MO 64108, USA
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5
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Plourde L, Chang SL, Farzin H, Gagnon P, Hébert J, Foxman R, Deschamps P, Provost F, Masse-Grenier M, Stephan JF, Cheung K, Joly Y, Fallu JS, Dorval M. Social acceptability of psilocybin-assisted therapy for existential distress at the end of life: A population-based survey. Palliat Med 2024; 38:272-278. [PMID: 38253521 PMCID: PMC10865753 DOI: 10.1177/02692163231222430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Internationally, there is a growing interest in the potential benefits of psilocybin-assisted therapy to treat existential distress at the end of life. However, the social acceptability of this therapy is not yet well known. AIM This study assesses the social acceptability of the medical use of psilocybin to treat existential distress at the end of life. DESIGN An online survey was conducted in Canada between November 23 and December 4, 2022. The questionnaire included items pertaining to perceptions, attitudes and concerns towards psilocybin-assisted therapy to treat existential distress at the end of life. PARTICIPANTS The sample (n = 2800) was stratified by province, age and sex. Participants were adults from four provinces of Canada: Québec, Ontario, Alberta and British Columbia. RESULTS Overall, 79.3% considered psilocybin-assisted therapy a reasonable medical choice for a patient suffering from existential distress at the end of life, 84.8% agreed that the public health system should cover the costs of the intervention and 63.3% would welcome the legalisation of psilocybin for medical purposes. Previous psilocybin use (p < 0.0001, for all dependent variables), exposure to palliative care (p < 0.05, for all dependent variables) and a progressive political orientation (p < 0.05, for all dependent variables) were associated with more favourable attitudes towards psilocybin-assisted therapy at the end of life. CONCLUSION The social acceptability of psilocybin-assisted therapy for existential distress at the end of life is rather high in Canada. These findings may contribute to efforts to mobilise resources and improve access to this emerging therapy in palliative and end of life care settings.
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Affiliation(s)
- Louis Plourde
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
| | - Sue-Ling Chang
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
| | - Houman Farzin
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Pierre Gagnon
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
- Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Johanne Hébert
- Department of Health Sciences, UQAR, Lévis, Rimouski, QC, Canada
- CISSS of Chaudière-Appalaches Research Center, Lévis, QC, Canada
| | | | | | - François Provost
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
- School of Psychology, Université Laval, QC, Canada
| | - Marianne Masse-Grenier
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
| | | | | | - Yann Joly
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre of Genomics and Policy, McGill University, Montréal, QC, Canada
| | - Jean-Sébastien Fallu
- School of Psychoeducation, Université de Montréal, Montréal, QC, Canada
- Center for Public Health Research (CReSP), Montréal, QC, Canada
- Institut universitaire sur les dépendances (IUD), Montréal, QC, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada
- CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada
- CISSS of Chaudière-Appalaches Research Center, Lévis, QC, Canada
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Gramling R, Bennett E, Curtis K, Richards W, Rizzo DM, Arnoldy F, Hegg L, Porter J, Honstein H, Pratt S, Tarbi E, Reblin M, Thambi P, Agrawal M. Developing a Direct Observation Measure of Therapeutic Connection in Psilocybin-Assisted Therapy: A Feasibility Study. J Palliat Med 2023; 26:1702-1708. [PMID: 37590474 DOI: 10.1089/jpm.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Context: Measuring therapeutic connection during psilocybin-assisted therapy is essential to understand underlying mechanisms, inform training, and guide quality improvement. Purpose: To evaluate the feasibility of directly observing indicators of therapeutic connection during psilocybin administration encounters. Methods: We evaluated audio and video data from a recent clinical trial for observable expressions of therapeutic connection as defined in proposed best-practice competencies (i.e., empathic abiding presence and interpersonal grounding). We selected the first four 8-hour encounters involving unique participants, therapists, and gender pairs. Each video was independently coded by three members of an interprofessional six-person team. Using a structured checklist, coders recorded start-stop times, the audible (i.e., speech prosody or words) and visible (i.e., body movements, eye gaze, and touch) cues marking the event, and the qualities of the interaction (e.g., expression of awe, trust, distress, and calmness). We assessed feasibility by observing the frequency, distribution, and overlap of cues and qualities coders used to identify and define moments of therapeutic connection. Results: Among the 2074 minutes of video, coders recorded 372 moments of therapeutic connection. Eighty-three percent were identified by at least two coders and 41% by all three. Coders used a combination of audible and visual cues to identify therapeutic connection in 51% of observed events (190/372). Both the cues and qualities of therapeutic connection expressions varied over the course of psilocybin temporal effects on states of consciousness. Conclusion: Direct observation of therapeutic human connection is feasible, sensitive to changes in states of consciousness and requires evaluation of audible and visual data.
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Affiliation(s)
- Robert Gramling
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Emily Bennett
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Keith Curtis
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Emergency Medicine, University of Vermont, Burlington, Vermont, USA
| | - William Richards
- Sunstone Therapies, Rockville, Maryland, USA
- Center for Psychedelic and Consciousness Research, John's Hopkins University, Baltimore, Maryland, USA
| | - Donna M Rizzo
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Department of Civil and Environmental Engineering, University of Vermont, Burlington, Vermont, USA
| | - Francesca Arnoldy
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
| | - Logan Hegg
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Jon Porter
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Osher Center for Integrative Health, University of Vermont, Burlington, Vermont, USA
| | | | - Susanna Pratt
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Elise Tarbi
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
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Baker KM, Ulrich CM, Meghani SH. An Integrative Review of Measures of Spirituality in Experimental Studies of Psilocybin in Serious Illness Populations. Am J Hosp Palliat Care 2023; 40:1261-1270. [PMID: 36604312 DOI: 10.1177/10499091221147700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Psilocybin-assisted therapies (PAT) are reemerging as a treatment for complex distress often prompting mystical experiences, enhanced meaning, and spiritual wellbeing. We sought to investigate how measures of spirituality are employed in experimental studies of PAT conducted with seriously ill adults. Methods: We included experimental studies of psilocybin conducted with seriously ill adults, which employed measures that contained spirituality and mysticism concepts within their domains or subdomains. Included studies were peer-reviewed and published in English language (up to December 2021). Results: Seven articles met our inclusion criteria. A total of 12 unique instruments were identified. The most frequently used instruments were the Mystical Experience Questionnaire (MEQ30), the Functional Assessment of Chronic Illness Therapy-Spirituality (FACIT-Sp-12), and the Demoralization Scale (DS-I/II) (used in four studies each), followed by the Persisting Effects Questionnaire (PEQ) (used in three studies). Overall, studies did not consistently define and contextualize spirituality domains and subdomains studied. Conclusions: Despite well-recognized significance of spirituality in PAT, there was considerable heterogeneity in number and types of spirituality measures employed across studies. There also seemed a lack of attention to defining and operationalizing spirituality and its domains and subdomains. This is notable as spirituality and overlapping concepts (eg mystical experiences) contributes substantially to this body of research and patients' therapeutic outcomes. Towards developing more rigorous science of spirituality in PAT research, there is a critical need to evaluate and refine measures of spirituality to enhance their utility and replicability, limit participant burden, and better contextualize spirituality-related findings and outcomes.
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Affiliation(s)
- Kayla M Baker
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
| | - Connie M Ulrich
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
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Miller M, Rosa WE, Doerner Rinaldi A, Addicott K, Spence D, Beaussant Y. Applying Key Lessons from the Hospice and Palliative Care Movement to Inform Psychedelic-Assisted Therapy. PSYCHEDELIC MEDICINE (NEW ROCHELLE, N.Y.) 2023; 1:124-129. [PMID: 37753521 PMCID: PMC10518906 DOI: 10.1089/psymed.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Background Psychedelic-assisted therapy (PAT) has re-emerged as a promising intervention for addressing mental health conditions and existential concerns. Despite growing enthusiasm, PAT may be difficult to integrate into mainstream health systems. The rich sacramental traditions of psychedelics, their centering of the human experience, proposed substrates of action, context-dependent outcomes, and highly relational method of therapy all challenge dominant reductionistic approaches of the biomedical model. Hospice and palliative care are well established as holistic evidence-based standards of care, yet they began as a radical grassroots movement. Hospice and palliative care models may offer unique insights to support the growing field of PAT. Purpose The intention of this commentary is to articulate the deep synergies between hospice and palliative care and PAT, with the intention of fostering interdisciplinary dialogue that may aid in implementation of human-centered high-quality PAT. Conclusions Various aspects of hospice and palliative care models were identified and explored, which may support the implementation of human-centered high-quality PAT at scale. These include a focus on truly interdisciplinary care, applying a holistic lens to health and illness, bearing witness to suffering and healing, customized care, centering human relationships, decentralized models of care, generalist/specialist competencies, fostering spirituality, organizing as a social moment around shared goals, and growth from grassroots community organizations to mature care systems. Although hospice and palliative care can offer practical lessons for scaling human-centered experiential therapies, PAT, with its radical centering of meaning-making and relationship in the healing process, may also mutually innovate the fields of hospice and palliative care.
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Affiliation(s)
- Megan Miller
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alden Doerner Rinaldi
- Care Dimensions Hospice, Danvers, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Katie Addicott
- Department of Palliative Medicine, Maine Medical Center, Portland, Maine, USA
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Yvan Beaussant
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana–Farber Cancer Institute, Boston, Massachusetts, USA
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9
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Rosenbaum D, Hales S, Buchman DZ. Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities. Healthc Policy 2023; 18:143-148. [PMID: 37486819 PMCID: PMC10370398 DOI: 10.12927/hcpol.2023.27047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We agree with Kratina et al. (2023) that the problem of psychological suffering at the end of life deserves attention from a policy standpoint and that psychedelic therapies show promise in this clinical context. However, we argue the following in this rejoinder: (1) disproportionate attention to psychedelics may overstate the current evidence base, potentially diverting resources away from existing evidence-based programs; (2) a more pressing policy priority related to this public health problem is to address population-level inequities in accessing high-quality, early and holistic palliative care, including psychosocial care; and (3) discussions about expanded access to psychedelics must also foreground equity issues.
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Affiliation(s)
- Daniel Rosenbaum
- Psychiatrist and Clinician Investigator, Nikean Psychedelic Psychotherapy Research Centre, University Health Network, Lecturer, Department of Psychiatry, University of Toronto, Toronto, ON
| | - Sarah Hales
- Psychiatrist and Clinician Investigator, Department of Supportive Care and Centre for Mental Health, University Health Network, Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON
| | - Daniel Z Buchman
- Bioethicist and Independent Scientist, Centre for Addiction and Mental Health, Assistant Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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10
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Ponomarenko P, Seragnoli F, Calder A, Oehen P, Hasler G. Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. J Psychopharmacol 2023:2698811231155117. [PMID: 36855289 DOI: 10.1177/02698811231155117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models. METHODS In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom's 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP. RESULTS We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training. CONCLUSION We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
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Affiliation(s)
| | | | - Abigail Calder
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
| | - Peter Oehen
- Private Practice for Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Gregor Hasler
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
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11
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Reynolds LM, Barnett B, Weleff J, Morunga E, Wells A, Stack A, Akroyd A, Hoeh N, Sundram F, Muthukumaraswamy S, Lawrence N, Evans WJ. The perceptions of cancer health-care practitioners in New Zealand and the USA toward psychedelic-assisted therapy with cancer patients: A cross-sectional survey. Palliat Support Care 2022:1-10. [PMID: 36325995 DOI: 10.1017/s1478951522001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES A resurgence of research investigating the administration of psychedelic compounds alongside psychotherapy suggests that this treatment is a promising intervention for anxiety, depression, and existential distress in people with cancer. However, psychedelic treatment that induces a mind-altering experience potentially poses barriers to vulnerable cancer patients, and health-care practitioners may have concerns about referring their patients to trials investigating this approach. The aim of the current study was to investigate the perceptions of cancer health-care practitioners based in New Zealand and the USA related to psychedelic-assisted therapy. METHODS This study utilized a cross-sectional survey of cancer health-care practitioners in New Zealand and the USA via convenience sampling to identify their perceptions about the concept of conducting psychedelic-assisted therapy with cancer patients. RESULTS Participants perceived that (1) psychedelic-assisted therapy has the potential to provide benefit for cancer patients, (2) research in this area across a variety of domains is important, (3) work should consider spiritual and indigenous perspectives of health, and (4) there was willingness to refer patients to trials in this area, especially patients with advanced disease who were no longer going through curative treatment. Participants in the USA had greater awareness of psychedelics than the New Zealand sample; however, New Zealand participants more strongly believed that spiritual/indigenous factors should be considered in psychedelic-assisted therapy. SIGNIFICANCE OF RESULTS Cancer health-care practitioners in our sample considered research investigating the potential for psychedelic-assisted therapies to be important and may be more open to studies that start in palliative and end-of-life contexts.
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Affiliation(s)
- Lisa M Reynolds
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Brian Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Eva Morunga
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Alesha Wells
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Aideen Stack
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Amelia Akroyd
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Nicholas Hoeh
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | | | - Nicola Lawrence
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
- The Department of Oncology, The University of Auckland, Auckland, New Zealand
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12
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Maia LO, Beaussant Y, Garcia ACM. The Therapeutic Potential of Psychedelic-assisted Therapies for Symptom Control in Patients Diagnosed With Serious Illness: A Systematic Review. J Pain Symptom Manage 2022; 63:e725-e738. [PMID: 35157985 DOI: 10.1016/j.jpainsymman.2022.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/20/2022]
Abstract
CONTEXT People affected by serious illness usually experience suffering in its various dimensions, not only in the physical but also in the psychosocial and spiritual aspects. The interest in psychedelic-assisted therapies as a potential new therapeutic modality has increased since evidence suggests a significant impact of their use on the outcomes of patients with serious illness. OBJECTIVES To systematically review the available evidence on the effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness. METHODS The protocol of this systematic review has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This review included randomized and non-randomized controlled trials published in peer-reviewed scientific journals. A comprehensive search for studies was carried out in the main scientific databases, including Web of Science, Scopus, Cochrane Library, PsycINFO, PubMed, CINAHL, and EMBASE. There were no limitations regarding the year or language of publication. RESULTS The sample was composed of 20 studies. The results suggest positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, with considerable safety of use. Most studies have been conducted with lysergic acid diethylamide, psilocybin, and N,N-dipropyltryptamine in cancer patients. The adverse effects reported were of physical and/or psychological nature and of mild to moderate intensity, transient, and self-resolutive. CONCLUSION The evaluated evidence suggests positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, especially regarding symptoms of psychological and spiritual nature.
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Affiliation(s)
- Lucas Oliveira Maia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil; Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO) (L.O.M.), School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care (Y.B.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
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13
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Rosa WE, Sager Z, Miller M, Bernstein I, Doerner Rinaldi A, Addicott K, Ljuslin M, Adrian C, Back AL, Beachy J, Bossis AP, Breitbart WS, Cosimano MP, Fischer SM, Guss J, Knighton E, Phelps J, Richards BD, Richards WA, Tulsky JA, Williams MT, Beaussant Y. Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness. J Palliat Med 2022; 25:1273-1281. [PMID: 35285721 PMCID: PMC9467634 DOI: 10.1089/jpm.2022.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychedelic-assisted therapy (PAT) is a burgeoning treatment with growing interest across a variety of settings and disciplines. Empirical evidence supports PAT as a novel therapeutic approach that provides safe and effective treatment for people suffering from a variety of diagnoses, including treatment-resistant depression, substance use disorder, and post-traumatic stress disorder. Within the palliative care (PC) field, one-time PAT dosing may lead to sustained reductions in anxiety, depression, and demoralization-symptoms that diminish the quality of life in both seriously ill patients and those at end of life. Despite a well-noted psychedelic renaissance in scholarship and a renewed public interest in the utilization of these medicines, serious illness-specific content to guide PAT applications in hospice and PC clinical settings has been limited. This article offers 10 evidence-informed tips for PC clinicians synthesized through consultation with interdisciplinary and international leading experts in the field with aims to: (1) familiarize PC clinicians and teams with PAT; (2) identify the unique challenges pertaining to this intervention given the current legalities and logistical barriers; (3) discuss therapeutic competencies and considerations for current and future PAT use in PC; and (4) highlight critical approaches to optimize the safety and potential benefits of PAT among patients with serious illness and their caregivers.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Megan Miller
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ilan Bernstein
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | | | - Katie Addicott
- Department of Palliative Medicine, Maine Medical Center, Portland, Maine, USA
| | - Michael Ljuslin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Chris Adrian
- Children's Hospital, Los Angeles, California, USA
| | - Anthony L. Back
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jamie Beachy
- Center for Contemplative Chaplaincy, Naropa University, Boulder, Colorado, USA
| | - Anthony P. Bossis
- NYU Grossman School of Medicine, New York, New York, USA
- NYU Langone Health Center for Psychedelic Medicine, New York, New York, USA
| | - William S. Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary P. Cosimano
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stacy M. Fischer
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey Guss
- NYU Grossman School of Medicine, New York, New York, USA
- Fluence International, Inc., Woodstock, New York, USA
| | - Emma Knighton
- American Psychedelic Practitioners Association, Seattle, Washington, USA
| | - Janis Phelps
- Center for Psychedelic Therapies and Research, California Institute of Integral Studies, San Francisco, California, USA
| | - Brian D. Richards
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Bill Richards Center for Healing, Sunstone Therapies, Aquilino Cancer Center, Rockville, Maryland, USA
| | - William A. Richards
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Bill Richards Center for Healing, Sunstone Therapies, Aquilino Cancer Center, Rockville, Maryland, USA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Garcia ACM, Maia LDO. The therapeutic potential of psychedelic substances in Hospice and Palliative Care. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, Brazil
| | - Lucas de Oliveira Maia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, Brazil
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Campinas, Brazil
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15
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Reynolds LM, Akroyd A, Sundram F, Stack A, Muthukumaraswamy S, Evans WJ. Cancer Healthcare Workers' Perceptions toward Psychedelic-Assisted Therapy: A Preliminary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158160. [PMID: 34360453 PMCID: PMC8346095 DOI: 10.3390/ijerph18158160] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Recent clinical trials suggest that psychedelic-assisted therapy is a promising intervention for reducing anxiety and depression and ameliorating existential despair in advanced cancer patients. However, little is known about perceptions toward this treatment from the key gatekeepers to this population. The current study aimed to understand the perceptions of cancer healthcare professionals about the potential use of psychedelic-assisted therapy in advanced cancer patients. Twelve cancer healthcare professionals including doctors, nurses, psychologists and social workers took part in a semi-structured interview which explored their awareness and perceptions toward psychedelic-assisted therapy with advanced cancer patients. Data were analysed using thematic analysis. Four inter-connected themes were identified. Two themes relate to the role and responsibility of being a cancer healthcare worker: (1) ‘beneficence: a need to alleviate the suffering of cancer patients’ and (2) ‘non-maleficence: keeping vulnerable cancer patients safe’, and two themes relate specifically to the potential for psychedelic-assisted therapy as (3) ‘a transformative approach with the potential for real benefit’ but that (4) ‘new frontiers can be risky endeavours’. The findings from this study suggest intrigue and openness in cancer healthcare professionals to the idea of utilising psychedelic-assisted therapy with advanced cancer patients. Openness to the concept appeared to be driven by a lack of current effective treatment options and a desire to alleviate suffering. However, acceptance was tempered by concerns around safety and the importance of conducting rigorous, well-designed trials. The results from this study provide a useful basis for engaging with healthcare professionals about future research, trial design and potential clinical applications.
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Affiliation(s)
- Lisa M. Reynolds
- Department of Psychological Medicine, The University of Auckland, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand; (A.A.); (F.S.); (A.S.)
- Correspondence:
| | - Amelia Akroyd
- Department of Psychological Medicine, The University of Auckland, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand; (A.A.); (F.S.); (A.S.)
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand; (A.A.); (F.S.); (A.S.)
| | - Aideen Stack
- Department of Psychological Medicine, The University of Auckland, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand; (A.A.); (F.S.); (A.S.)
| | - Suresh Muthukumaraswamy
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand;
| | - William J. Evans
- Mana Health, 7 Ruskin Street, Parnell, Auckland 1052, New Zealand;
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