Experts in palliative care, oncology, psychiatry, and psychedelic-assisted therapy identified special considerations for using psychedelics near the end of life. They emphasized a non-medicalized setting, the potential to reduce preparation time, and the importance of addressing anxiety, depression, and spiritual distress. Dosing flexibility was recommended: low-to-medium doses for relational issues, higher doses for transcendental experiences. Therapists need knowledge of mystical states, existential aspects of life-threatening illness, and their own inner work. The findings provide a first step toward specific treatment recommendations for psychedelic-assisted therapy in palliative care.
Psychedelic-assisted therapies, including ketamine-assisted psychotherapy, show promise for reducing depression, anxiety, and existential distress in patients with life-limiting illness, primarily in early-phase oncology studies. A review of 22 studies found consistent improvements in quality of life and spiritual well-being, with generally favorable safety under controlled conditions. However, the evidence remains preliminary, drawn from small, methodologically diverse studies with limited blinding and highly selected populations. The incorporation of key therapeutic practices—such as preparation, integration, and clinician training—was uneven across the literature, revealing a gap between research evidence and emerging clinical recommendations.