Background/Significance Psychological, existential, and spiritual distress are well-recognized components of patients' experiences with serious illness and at end of life, and there is limited efficacy in managing these symptoms with current treatment modalities. While hospice and palliative care address these dimensions of patient experience by providing holistic care, patients still experience clinically significant degrees of psychological, existential, and spiritual distress. Since the 1970s, there has been interest in the role of psychedelic-assisted therapies (PAT) in addressing this distress. In the last 20 years, there has been a new wave of more rigorous methodologies assessing the safety and efficacy of PAT for psycho-existential distress in patients with serious illness, which have shown a safe, rapid, and sustained effect in reducing distress. Most recent studies are focused on how to best integrate PAT into existing models of serious illness care. We present the first study of the feasibility of using PAT for demoralization in patients receiving hospice care.
Methods: This is an open-label, pilot study assessing the feasibility of psilocybin-assisted therapy for patients with demoralization who are receiving hospice care. Eligible patients are enrolled through a non-profit community hospice agency and are administered a single dose of psilocybin (25mg) in the context of a psychotherapeutic intervention (2 hours of preparation, 8 hours dosing day, and 2 hours of integration) with a therapist dyad. Primary outcomes are feasibility of enrollment, retention, and assessment, as well as patient acceptability. Secondary outcomes include safety, demoralization, depression and anxiety, spiritual well-being, mystical experience, and caregiver quality of life.
Results: So far we have enrolled 8 patients and treated 5 of them successfully. We have had no serious adverse events. Managing concurrent physical symptoms as a result of disease during the treatment has presented a challenge and a point of discussion. Patients have shown improvement in their demoralization scores as well as depression and anxiety. We have extensively interfaced with the hospice interdisciplinary teams at each step of patient participation as well as patient families. Patients have had a range of subjective experiences with psilocybin, including mystical experiences, feeling little effect, and distress, at times each during one session. Themes of working through grief, deepening trust in oneself, and transcending prior narratives of illness have begun to emerge.
Discussion: Integration with the existing care structures offered by the hospice interdisciplinary team and patient families is a critical part of containing the powerful, at times disruptive, experience of PAT for patients receiving hospice care. Qualitative interviews of patients and caregivers will reveal more of the subjective nature of the experience.
Conclusions/Implications: We continue to enroll to our target of 15 patients to receive PAT while receiving hospice care for demoralization. Mechanisms of therapeutic action will be analyzed and reported on. Feasibility of performing this intervention on this population will be determined.
References: Kozlov E, Phongtankuel V, Prigerson H, et al. Prevalence, Severity, and Correlates of Symptoms of Anxiety and Depression at the Very End of Life. J Pain Symptom Manage. 2019;58(1):80–85.
