Schuldt Anna, Clark Ian C, Schmid Yasmin, Ljuslin Michael, Boehlke Christopher, Schipper Sivan, Sands Megan B, Blum David
Center for Palliative Care, University Hospital Zurich, 8091 Zurich, Switzerland.
University of Zurich, 8006 Zurich, Switzerland.
Healthcare (Basel). 2025 Sep 12;13(18):2275. doi: 10.3390/healthcare13182275.
Evidence is growing that psychedelic substances have positive effects in the setting of Palliative Care (PC), focusing on special needs in this patient population. After a scoping review of the literature, no published expert recommendations guiding best practice for psychedelic-assisted therapy (PAT) towards the end of life were identified. To draw conclusions from first-hand experienced professionals on PAT in PC (PATPC). An international workshop with experts was held in Wasserfallen, Switzerland. A thematic analysis of a semi-structured, questionnaire-based qualitative study with 13 experts in PC, oncology, psychiatry/psychology, and PAT from Europe, the United States, and Oceania was made. The questionnaire was designed to elicit the participant's perspectives on (A) special considerations on PATPC, (B) specific characteristics of PATPC (versus mental illness), and (C) the relevance of these differences during preparation, substance dosing session, and integration in PATPC. (A) Special Considerations included (non-medicalized) setting, potential need, and possibility to reduce preparation time. (B) Distinguishing characteristics included the patient's intrinsic motivation for treatment success, the importance of anxiety, depression, and spiritual distress as indications for PATPC, and the importance of sufficient integration of the psychedelic experience into life in the face of limited time due to the life-limiting illness. (C) Flexibility in setting and timing of preparation, choosing the appropriate dosage of the psychedelic substance depending on the patient's intended focus, low/medium (relational issues), higher for transcendental experiences, considering mental capacity and vulnerability for the individual. In addition, respondents noted that for therapists, knowledge about transcendental states, such as mystical experiences, existential aspects of life-threatening illness, and the role of therapists' own self-experience/inner work, as well as good knowledge of the theoretical basis for treatment, was highlighted. This study highlights special considerations for PAT PC and could be a first step towards specific treatment recommendations (guidelines) for PATPC.
越来越多的证据表明，迷幻物质在姑息治疗（PC）中具有积极作用，尤其关注这一患者群体的特殊需求。在对文献进行范围综述后，未发现有已发表的专家建议可指导临终阶段迷幻辅助治疗（PAT）的最佳实践。为了从在PC中进行PAT（PATPC）的有第一手经验的专业人员那里得出结论，在瑞士瓦瑟法伦举办了一次有专家参加的国际研讨会。对来自欧洲、美国和大洋洲的13名PC、肿瘤学、精神病学/心理学及PAT领域的专家进行了一项基于问卷的半结构化定性研究，并进行了主题分析。该问卷旨在引出参与者对以下方面的看法：（A）PATPC的特殊考量；（B）PATPC（与精神疾病相比）的具体特征；（C）这些差异在PATPC的准备阶段、药物剂量设定阶段以及整合阶段的相关性。（A）特殊考量包括（非医学化的）环境、潜在需求以及减少准备时间的可能性。（B）区别特征包括患者对治疗成功的内在动力、焦虑、抑郁和精神痛苦作为PATPC指征的重要性，以及由于生命有限性疾病导致时间有限的情况下，将迷幻体验充分融入生活的重要性。（C）准备阶段的环境和时间安排的灵活性，根据患者预期的关注点选择合适的迷幻物质剂量，对于关系问题选择低/中等剂量，对于超验体验选择较高剂量，同时考虑个体的心理能力和脆弱性。此外，受访者指出，对于治疗师而言，关于超验状态的知识，如神秘体验、危及生命疾病的存在主义方面以及治疗师自身的自我体验/内心工作的作用，以及对治疗理论基础的充分了解，都很重要。这项研究突出了PAT PC的特殊考量，可能是朝着制定PATPC的具体治疗建议（指南）迈出的第一步。
